Swimming Consent Form

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Year 4 Willow class

Child's Name: *

Your Name: *

Name of family doctor *

Telephone Number of Doctor's Surgery *

Address of Doctor's Surgery: *

Is your child able to swim for 50 metres *

Yes

Other:

Is your child water confident in a pool? *

Yes

Other:

Is your child safety conscious in water? *

Yes

Other:

I would like my child to take part in weekly swimming lessons and having read the information provided, agree to them taking part in the activities described. *

Yes

I consent to any emergency medical treatment required by my child during the course of the visit *

Yes

I confirm that my child is in good health and I consider them fit to participate *

Yes

Required

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