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                                        This is a sample release form I would use to give my Daycare parents.

                                              Swimming  Pool Water Play Release

_______________________________(daycare name) has many activities involving water throughout the year. These include, but not limited to:

·                    Water Sensory Table

·                    Water Bottles

·                    Swimming Pool

·                    Bathing a soiled child.

Upon signing this form you agree to permit your child: 

____________________________________            Age: __________

____________________________________            Age: __________

to participate in water activities.

(    )    I approve.
(    )    I do not approve.

            By signing below, you agree that this is a legally binding form.  Providing false information could be grounds for termination of childcare services, forfeiture of retainer, or both.

Father/Guardian’s Signature

 

Date

Mother/Guardian’s Signature

 

Date

 

Provider Signature

 

Date