Unaccompanied Minors – Holmes Run Pool

Parent Name *

First

Last

Email *

Mobile Phone

Work or Home Phone

Alternate Emergency Contact

Enter the name and phone number of the person you would like us to call if you can't be reached.

Name *

First

Last

Phone *

Child Information

I hereby give permission for the minor child named below to swim at HRARA and use other pool facilities without an adult chaperone.

Child Name *

First

Last

Mobile Phone *

Birth Date *//

Age *

Select your child's age as of today.

Child Agreement to HRARA Code of Conduct

I attest that I have asked my child (named above) to read the following and check each box to acknowledge that they understand their responsibilities and agree to abide by each item listed.

I agree to the following Code of Conduct in order to have the privilege of swimming at HRARA without an adult chaperone. I understand if I violate this agreement that my privilege can be suspended or revoked at any time. *

I will follow all posted rules at HRARA.

2 *

I will listen and follow the directions of the lifeguards at all times.

3 *

I will not use profanity.

4 *

I will use polite and courteous behavior.

Parent Agreement

I attest that I myself have read and understand the following. Checking each box acknowledges that I understand my responsibilities and those of my child and agree to abide by each item.

I agree to the HRARA Code of Conduct that is expected of my child. As the parent issuing permission for my minor child to have the privilege of swimming at HRARA unaccompanied, I also agree to the following: *

I will be accessible in a reasonable length of time (30 minutes) if HRARA needs to contact me regarding my child.

2 *

I or another adult can be reached at the phone numbers above at all times my child is at the pool.

3 *

If my child’s privilege is revoked at any time and they are asked to leave the facility, I am responsible for their whereabouts

4 *

I give the lifeguards the authority to determine if my child’s conduct is reasonable and acceptable with regards to the posted rules and the Code of Conduct listed above.

5 *

I acknowledge that HRARA is not a babysitting service and that my child’s safety and well-being is my parental responsibility.

Babysitting

Does your 14-17 year old child have permission to supervise or babysit other children under the age of 11 at the pool? *

We (parent and child) I attest that we have read, understand and agree to abide by the following rules: *

Babysitters must coordinate with pool management and pass a swimming proficiency test prior to bringing children to the pool.

2 *

Babysitters should directly and attentively supervise the children in their care at all times.

3 *

Babysitters must assist lifeguards by enforcing all HRARA policies and procedures with the children under their supervision.

4 *

Babysitters must be responsible and mature in dealing with children in their care.

5 *

Babysitter privileges to supervise children at the pool may be revoked for the remainder of the season at any time for not meeting the above guidelines. Lifeguards have the authority to determine, in their sole discretion, if the babysitting child’s conduct is reasonable and acceptable with regards to the posted rules and the Code of Conduct listed above.

Signature

By entering your name and your child's name below, you are agreeing that you have reviewed and agree to all of the terms of this HRARA Unaccompanied Minor Form. Your submission of this form constitutes a legally binding document.

Parent Signature *

Parent Name *

First

Last

Today's Date *

Child Signature *

Child Name *

First

Last

Today's Date *

About Us » Unaccompanied Minors

Unaccompanied Minor Form

Alternate Emergency Contact

Child Information

Child Agreement to HRARA Code of Conduct

Parent Agreement

Babysitting

Signature