Hamdan Bin Zayed C2 & 3 School
SWIMMING – PARENTAL CONSENT FORM
Name:………………………….………………………… School:……….…………………………………
Date of Birth:…....……………………………………… Class………….………………………………..
Address: …………………...……………….…………………………………..…………..........................
…………………………………………………………………………………………………………………
Tel. No. ……………….………………………….
As part of your child’s education he/she will be undertaking swimming lessons this year. It is important
that the swimming teacher has the following information concerning your child.
Please tick ( ) on the box if Yes or No.
I. Questions Yes No
1. Does your child suffer from any of the following?
• Asthma (please bring inhaler to every swimming session)
• Epilepsy
• Sensory impairment e.g. deaf
• Grommets (recommend wearing a swimming cap & ear plugs)
• Diabetes
2. Does your child take medication on a regular basis? Give details.
3. Does your child have any other medical conditions? Give details.
4. Please give details of any past or present injuries e.g. Fractures
II. Swimming Ability
Non-swimmer 5m 10m 25m 50m+ Any other awards (please specify):
ODC2022‐Form001
Chemicals in the water in swimming pools adversely affect my child’s eyes. I give my permission for my
child to wear goggles during swimming lessons and accept responsibility should my child be injured as
a result of wearing goggles.
I am aware that my child may be asked to remove their goggles for specific water or diving
activities for safety reasons.
I am aware that all jewelry is to be removed prior to swimming activities.
I am aware that my child is required to bring the following items in order to be allowed to participate in the
swimming lessons:
1. Goggles
2. Swim cap
3. Swimming trunks
4. Towel
5. Body wash / soap
6. Plastic flip flops / sandals
7. Waterproof bag labeled with the student name – all items must fit into the bag
Signature of Parent/Guardian …………………….……………….
Date …………………………………………………………………….
*Note: Please note your child will not be allowed to swim unless this form is completed. Please
return this form to Hamdan Bin Zayed C2 & 3 School.
ODC2022‐Form001
