PARENT/CHILD WAIVER FORM

This waiver form gives my consent to Durant Trails that my child who is between 11-13
years old to be at the Durant Trails pool area without supervision and accept full
responsibility for his/her actions. If their behavior is deemed unacceptable by the
lifeguard(s) on duty at the time, then I will be contacted AND will pick them up
immediately. Also, if a parent is contacted for misbehavior, then the child will no longer
be permitted at the pool area without adult supervision.

Date: ____________________

Name of parent/legal guardian: ___________________________________

Address: _____________________________________________________

Name of child: ________________________________________________

Child’s age: ________ Child’s date of birth: _______________________

Gender: ________________

Primary phone contact number: ____________________________________

Secondary phone contact number: __________________________________

Parent’s signature: ______________________________________________

Child’s signature: _______________________________________________