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Ohio Department of Job and Family Services

PERMISSION TO PARTICIPATE IN WATER AND SWIMMING ACTIVITIES
FOR CHILD CARE

Written parental permission is required for the water activities your child will be engaging in when:
(check all that apply for this activity)

Water is directly accessible to child (no water activities planned) Child swimming or playing in water 18 inches or more in depth Infants and toddlers using wading pools

The program is providing additional adults or child care staff members that exceed the licensing ratio requirements for the water/swimming activity.
(The program is to meet the minimum ratio requirements outlined in rule).

YesNo

Swim Site

Date(s)

Departure/Arrival Times from Program

Mode of Transportation (parents driving, provider vehicle, public transportation, school bus, etc.)

I give permission for my child to participate in the swimming/water activity listed above.

Child's Name

Child's Date of Birth

My child is a

SwimmerNon swimmer

Parent's Signature

Date

JFS 01227 (Rev. 10/2021)

PERMISSION TO PARTICIPATE IN WATER AND SWIMMING ACTIVITIESFOR CHILD CARE

PERMISSION TO PARTICIPATE IN WATER AND SWIMMING ACTIVITIES
FOR CHILD CARE