Ensuring the safety and well-being of children during swimming activities in child care settings is a matter of great importance. The Parent Permission for Swimming form plays a crucial role in this process, serving as a formal acknowledgment by parents or legal guardians of the risks associated with swimming pool use. This document not only informs parents about the potential risks involved but also provides them the choice to consent to or deny the use of a swimming pool for their child(ren) under the care of a provider. By signing this form, parents assert that they have been adequately informed through the “Fact Sheet: Risks of Swimming Pools at Child Care Homes” and have had the opportunity to discuss any concerns with the child care provider. Importantly, it highlights a key disclaimer that the provider's pool may not be subject to inspections or monitoring by health and social services agencies, underscoring the responsibility of parents in making informed decisions regarding their child's participation in swimming activities. With spaces allocated for the signatures of both the parent or legal guardian and the child care provider, along with the names of the child(ren) involved, this consent form is a vital document ensuring clear communication and agreement on the participation in swimming activities, thereby helping to safeguard the interests and safety of children in child care environments.
| Question | Answer |
|---|---|
| Form Name | Parent Permission Form For Swimming |
| Form Length | 1 pages |
| Fillable? | Yes |
| Fillable fields | 16 |
| Avg. time to fill out | 3 min 31 sec |
| Other names | nh pool form, permission form swimming, parental consent form for swimming, permission letter for swimming |
SWIMMING POOL CONSENT FORM
By signing this form, I am acknowledging that I have read the document titled: “Fact Sheet: Risks of Swimming Pools at Child Care Homes”, I have been given the opportunity to talk with my child care provider about the use of the swimming pool, and I understand the risks associated with the use of a swimming pool by my child(ren) while they receive child care services.
By signing this form, I acknowledge that the provider’s pool may not be inspected or monitored by the Department of Health, the Department of Human Services or the county social services agency.
_____ I DO consent to my child care provider’s use of the swimming pool with my
child(ren).
_____ I DO NOT consent to my child care provider’s use of the swimming pool with
my child(ren). |
|
|
___________________________ |
________ |
________________________ |
Signature of Parent or |
Date |
Name(s) of child(ren) |
Legal Guardian |
|
|
_____________________________ |
________ |
Signature of Child Care Provider |
Date |
NH DHHS, Division of Public Health Services |
September 2011 |
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Health Officers Manual |
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