REQUIRED – Must return with signature

SWIMMING PERMISSION SLIP

Dear Parents,

In order for your child to participate in swimming and pool activities at Outdoor
Science School, we must have your permission. Please complete this form and
return it to your child’s teacher by January 20, 2011.

I give permission for my child to participate in swimming and pool

activities while attending Mount Hermon Outdoor Science School from
Feb. 22 – 25, 2011.

I do not give permission for my child to participate in swimming and pool

activities while attending Mount Hermon Outdoor Science School from
Feb. 22 – 25, 2011.

Child’s Name: ______________________ Rm.# ____

Parent’s Name: _______________________________

Parent’s Signature: ____________________________

My child’s swimming ability is designated as: (check one)

 REQUIRED – Must return with signature

Swim
Team
B
eginn
er Lifeguard

A
d
v
a
n
c
e

B
e
g
i
n
n
e
r

I
n
t
e
r
m
e
d
i
a
t
e

Advance