YMCA of Greater Cleveland

Routine Field Trip and Swimming Permission Form

Routine Trip Destination(s) / French Creek
Recreation Pool
Date of Permission (valid for one year) / June 2016-August 2016
Departure/Arrival Times from Center / 1:00pm-2:30PM
Transportation services will be provided by (YMCA Staff check one):
____ YMCA owned/operated bus _____ Leased bus with YMCA driver ___X__ Children walking
____ Contracted bus services through school district
In any of the above field trips, will children have access to water that is two or more feet in depth?
No Yes
If yes, list field trip destination(s): French Creek Recreation Pool
Are water activities planned in water that is two or more feet in depth? No Yes If yes, complete swimming permission section
My child is c over 4 years and 40 lbs. c not over 4years and/or 40 lbs.

ROUTINE TRIP

SWIMMING TRIP

Licensing rules 5101:2-12-17 and 5101:2-13-17 require parental permission for the water activities your child will be engaging in: (YMCA check one)
Ö Swimming in water two feet or more in depth.
  Child participates in activities near water two feet or more in depth - no water activities planned.
  Before infants and toddlers use wading pools.
The center will NOT be providing additional adults above the required staff /child ratios.
Swim site / French Creek Family YMCA
2010 Recreation Lane, Avon, OH 44011
Date(s)
Thursday’s / 6/9/16,6/16/16,6/23/16,6/30/16,7/7/16,7/14/16
7/21/16,7/21/16,7/28/16,8/4/16,8/11/16,8/18/16
Departure/Arrival Times from Center / 1:00pm-2:30pm
Transportation services will be provided by (YMCA Staff check one):
____YMCA owned/operated bus ____ Leased bus with YMCA driver __x__Children Walking
____Contracted bus services through school district
MY CHILD IS A _____ SWIMMER _____ NON-SWIMMER
Swimming Ability (check one) ____ swimmer ____ non-swimmer _____ beginner
____ intermediate ____ advanced
MY CHILD HAS PERMISSION TO PARTICIPATE IN WATER ACTIVITIES ____ YES ____ NO

SPECIAL INSTRUCTIONS FOR FIELD TRIPS:

In the consideration of the opportunity for my child to be a participant in the YMCA of Greater Cleveland’s child care field trip, I, the parent or guardian, hereby assume all risks and release and hold harmless the Association and all its members, volunteers and employees from any claim that might arise as the result of my child’s participation in the field trip including transportation related to the field trip. I have read the above and willingly consent to allow my child’s participation under the above stated condition.

______

CHILD’S NAME DATE OF BIRTH

______

PARENT/GUARDIAN SIGNATURE DATE