Permission To Participate In Water Activities Form
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1Permission to Participate in Water Activities
I, ___________________________________________________ am the legal guardian of the following
minor children:
Name
Address
Age
I understand and acknowledge that my child(ren) will be involved in water activities, such as swimming,
canoeing, kayaking, and boating at:
Name of event
Location of event
Date of event
I understand and acknowledge that my child(ren) will be involved in water activities and that these
activities have inherent risks associated with them, including but not limited to sunburn, skin and hair
irritation, other bodily injury and even death. Some water activities require that girls be able to pass a
basic swim test. I am acknowledging their abilities and providing permission.
In the event of an injury, I consent to emergency medical attention for my child.
I acknowledge that my child(ren) can pass a Red Cross Swim Test for Beginners including the following:
jump feet first into the water ________ (initial here)
level off and swim 25 feet on the surface ________ (initial here)
stop and turn sharply ________ (initial here)
resume swimming ________ (initial here)
return to the starting place ________ (initial here)
Additionally, I have advised my child to listen to and respect lifeguards, water activity instructors and all
adults involved in administering water activities regarding rules and procedures.
Parent/Guardian printed name _____________________________________ Date: ________________
Parent/Guardian signature ______________________________________________________________
Address ____________________________________________________________________________
City ________________________________ State _______________ Zip Code __________________
_________
Phone ____________________________ Email __________________________________
Girl Scouts of Gulfcoast Florida, Inc. 4780 Cattlemen Rd., Sarasota, FL 34233
800-232-4475 or 941-921-5358
Sharepoint: MVPS/VolunteerResources/VolunteerManagement/Forms/WaiverforWaterActivities – Rev:6/16
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