Form DHS-7749A "Swimming Pool Permission Form" - Minnesota

What Is Form DHS-7749A?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Minnesota Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DHS-7749A by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

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Download Form DHS-7749A "Swimming Pool Permission Form" - Minnesota

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DHS-7749A-ENG
Swimming Pool Permission Form
Family Child Care
Dear Parent or Legal Guardian:
The 2002 Minnesota Legislature passed a bill that allows swimming pools to be used by family and group family
child care providers when certain requirements are met. These requirements are specified in
Minnesota
Statutes section 245A.14, subdivision 11.
A swimming pool may be used only if all of the following requirements are met:
The parent or legal guardian of the child has provided written consent to the license holder which includes a
statement that the parent or legal guardian has received and read the document written by the Department of
Human Services and the Department of Health titled: “Swimming Pool Risks” and also includes a statement that
the Department of Health, Department of Human Services, and the county agency will not monitor or inspect
the provider’s pool;
The parent or legal guardian has entered into a written contract with the child care provider that specifies that
the provider agrees to comply with all the requirements in
Minnesota Statutes, section 245A.14 subdivision 11;
and
The provider has not received a correction order or conditional license related to supervision or health and
safety of children within the previous 24 months.
Please read the Swimming Pool Risks form, as well as the legislation (a link to the statutory language is located
at the end of this page) and decide whether or not to permit your child(ren) to use the swimming pool while
under the care of your family child care provider.
If you have questions about the changes regarding swimming pools, please contact your local public health
department or the Minnesota Department of Health. If you have questions about child care licensing you
should contact your local county Social Services Agency, or you may call the Minnesota Department of Human
Services.
After completion, please give this form to your child care provider. This form will document your decision.
By signing this form, I am acknowledging that I have read the document written by the Department of Human
Services and the Department of Health titled: “Swimming Pool Risks.” 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.
6/2018
1
DHS-7749A-ENG
Swimming Pool Permission Form
Family Child Care
Dear Parent or Legal Guardian:
The 2002 Minnesota Legislature passed a bill that allows swimming pools to be used by family and group family
child care providers when certain requirements are met. These requirements are specified in
Minnesota
Statutes section 245A.14, subdivision 11.
A swimming pool may be used only if all of the following requirements are met:
The parent or legal guardian of the child has provided written consent to the license holder which includes a
statement that the parent or legal guardian has received and read the document written by the Department of
Human Services and the Department of Health titled: “Swimming Pool Risks” and also includes a statement that
the Department of Health, Department of Human Services, and the county agency will not monitor or inspect
the provider’s pool;
The parent or legal guardian has entered into a written contract with the child care provider that specifies that
the provider agrees to comply with all the requirements in
Minnesota Statutes, section 245A.14 subdivision 11;
and
The provider has not received a correction order or conditional license related to supervision or health and
safety of children within the previous 24 months.
Please read the Swimming Pool Risks form, as well as the legislation (a link to the statutory language is located
at the end of this page) and decide whether or not to permit your child(ren) to use the swimming pool while
under the care of your family child care provider.
If you have questions about the changes regarding swimming pools, please contact your local public health
department or the Minnesota Department of Health. If you have questions about child care licensing you
should contact your local county Social Services Agency, or you may call the Minnesota Department of Human
Services.
After completion, please give this form to your child care provider. This form will document your decision.
By signing this form, I am acknowledging that I have read the document written by the Department of Human
Services and the Department of Health titled: “Swimming Pool Risks.” 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.
6/2018
1
DHS-7749A-ENG
By signing this form, I acknowledge that the provider’s pool will not be inspected or monitored by the
Department of Health, the Department of Human Services or the county social services agency.
By signing this form, I am acknowledging that I have entered into a contract with my child care provider and that
the contract specifies that the provider agrees to perform all of the requirements in
Minnesota Statutes section
245A.14, subdivision
11. I understand that the county social services agency will NOT monitor the terms of my
contract with the family child care provider.
By signing this form I am acknowledging that I understand that if my child care provider receives a correction
order or a conditional license related to the supervision or health and safety of children, the provider is then
prohibited from allowing children cared for to continue to use the swimming pool located at the home.
___ 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).
_______________________________________________________________
Name of Child)ren
________________________________________
______________________________________
Signature of Parent and Date
Signature of Provider and Date
6/2018
2
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