EPOSHC - Swimming Permission

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EPOSHC
Swimming Ability Form

Child's Name:*

Child's DOB: *

Confidence around the water:

Please check the appropriate space and provide comments if necessary:*

Very Confident

Somewhat Confident

Not Confident

Comments:

Swimming Ability:

*

Non-Swimmer (cannot support themselves in the water)

Novice (can support themselves in shallow water and are capable of moving short distances <5m)

Intermediate (can support themselves in deep water and can swim a length of the pool)

Advanced (can support themselves in deep water and can competently swim lengths of the pool)

Health Considerations:

Special Needs or Preferences:

Long answer

Emergency Contact Information

Guardian Name:*

Phone*

Today's Date:*

Signature

First Name

Last Name

Email Address

Message...

Message Received! Thanks for reaching out!

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