Family Child Care Sample Forms Packet Page 10
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12Permission for Use of On-Site Swimming Pool
This form can be used by Educators who have a swimming pool on the program
premises.
I hereby give _________________________________________ permission to allow my child
Educator(s)
____________________________ who is ___________________years old to use the on-site
swimming pool at the program. I understand that my child must be directly supervised by the
Educator(s) at all times, and that there will be a second adult on the premises to assist in case
of an emergency whenever the pool is in use.
__________________________________
__________________________
Parent’s/Guardian’s Signature
Date
Page 10 of 12
FCCSampleFormPacket20100203
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