"Permission Form to Participate in Swimming Activities" - Georgia (United States)

Permission Form to Participate in Swimming Activities is a legal document that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States).

Form Details:

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Center Name: ______________________________________________________
Child’s Name: ______________________________________________________
Date of Birth (include year): _________________________________________
I give ________________________________ permission to participate in
swimming activities.
________________________________________
________________
parent signature
date
To be completed by swim instructor
______________________________________ has successfully completed a
swimming test which required the child to swim a distance of fifteen
(15) yards unassisted.
_______________________________ (lifeguard) has current evidence of having
completed successfully a training program in lifeguarding offered by a water-
safety instructor certified by the American Red Cross or YMCA or YWCA or other
recognized standard-setting agency for water safety instruction.
(Center must maintain a copy on file)
______________________________________________
_____________________
signature of lifeguard or instructor
date
Center has obtained a letter from the off-site swimming facility that all
lifeguards on duty have successfully completed a training program in
lifeguarding.
** In lieu of requiring each child to take a swimming test to determine whether
the child can swim a distance of fifteen (15) yards unassisted, center staff may
accept copies of certificates or cards from a recognized water-safety instruction
organization showing that the child has successfully completed a swimming class
which required the child to swim a distance of fifteen (15) yards unassisted.
Center Must Maintain in Child’s File
Center Name: ______________________________________________________
Child’s Name: ______________________________________________________
Date of Birth (include year): _________________________________________
I give ________________________________ permission to participate in
swimming activities.
________________________________________
________________
parent signature
date
To be completed by swim instructor
______________________________________ has successfully completed a
swimming test which required the child to swim a distance of fifteen
(15) yards unassisted.
_______________________________ (lifeguard) has current evidence of having
completed successfully a training program in lifeguarding offered by a water-
safety instructor certified by the American Red Cross or YMCA or YWCA or other
recognized standard-setting agency for water safety instruction.
(Center must maintain a copy on file)
______________________________________________
_____________________
signature of lifeguard or instructor
date
Center has obtained a letter from the off-site swimming facility that all
lifeguards on duty have successfully completed a training program in
lifeguarding.
** In lieu of requiring each child to take a swimming test to determine whether
the child can swim a distance of fifteen (15) yards unassisted, center staff may
accept copies of certificates or cards from a recognized water-safety instruction
organization showing that the child has successfully completed a swimming class
which required the child to swim a distance of fifteen (15) yards unassisted.
Center Must Maintain in Child’s File