Water Play Consent Form

Michelle Jensens Daycare/ Ms. Shells Daycare has many activities involving water throughout
the year. These include, but not limited to:

Water Sensory Table

Sprinkler

Hand Crank Water Pump

*** We never use the pool or gain access to the deck around the pool.
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/Guardians Signature

Date

Mother/Guardians Signature

Date

Provider Signature

Date