Swimming Consent Form
Name of the Scholar :- …………………………………
Scholar Father’s Name :-…………………………………………………..
Affix scholar’s ….............
photo here
Parent’s Contact No :- ……………… Emergency Contact No:-……...
…………....
Address :- …………………………………………….…………………..
……………..
……………………………………………..……….… City……………..
………………
Gender : - Male Female Blood Group : -………..
………………...
I/We, Mr. / Mrs. :- ……………………………………………….. Parent/Parents’ of …………..
……………….
Studying in Grade ……………… of S R International School & Sports Academy, NH-
24, BKT, Lucknow, do hereby give my willing consent for my ward to use the school’s
swimming pool. I will not hold the School responsible for any accident that may
inadvertently occur during the course of such use and swimming activity.
Date : - Note
……………. You can rest assured that the school will take all
safety precautions while conducting swimming
classes, including the presence of a qualified
Parents’ swimming coach, lifeguard, security guard and
Signature inflated tubes. Swimming activity will be properly
supervised. However, swimming can only be
permitted on receipt of the signed Consent Form,
Signature of the
Receiving with an attested medical certificate, enclosed
Authority School herein.
Office
For Office Use Only
Date of receiving the form :- ………..…… Received by (School Office) :-
……………………
Swimming Consent Form
Name of the Scholar :- ………………………………… Grade :-
……………....….
Affix scholar’s Scholar Father’s Name :-…………………………………………………..
photo here ….............
Parent’s Contact No :- ……………… Emergency Contact No:-……...
…………....
Address :- …………………………………………….…………………..
……………..
……………………………………………..……….… City……………..
………………
Gender : - Male Female Blood Group : -………..
………………...
I/We, Mr. / Mrs. :- ……………………………………………….. Parent/Parents’ of …………..
……………….
Studying in Grade ……………… of S R Global School, NH-24, BKT, Lucknow, do
hereby give my willing consent for my ward to use the school’s swimming pool. I will not
hold the School responsible for any accident that may inadvertently occur during the
course of such use and swimming activity.
Date : - Note
……………. You can rest assured that the school will take all
safety precautions while conducting swimming
classes, including the presence of a qualified
Parents’ swimming coach, lifeguard, security guard and
Signature inflated tubes. Swimming activity will be properly
supervised. However, swimming can only be
permitted on receipt of the signed Consent Form,
Signature of the
Receiving with an attested medical certificate, enclosed
Authority School herein.
Office
Medical Certificate
This is to certify that I have
examined of age And found that
he / she is not suffering from any
Doctors’ Signature
chronic / contagious disease or (Name & Stamp with Regn. No.)
any disability Which prevents Date : -
…………………………………………….
him/her from attending the
Note- This certificate has to be signed by
swimming classes. Regd. MBBS Doctor.
For Office Use Only
Date of receiving the form :- ………..…… Received by (School Office) :-
……………………
