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Guest Waiver for Rules and Rock Wall


This form must be filled out online by a parent or legal guardian for the minor. After completion of the form, your information will remain on file for the entire summer season.

If you are a member, this form has already been signed as a part of your membership application. Members DO NOT need to fill out the form again.

 

Read the Summer Break Rules for Guests & Rock Wall here.


Contact Info






Family Information


Family Member #1 Full Name (This MUST be the LEGAL GUARDIAN if children are being added to the form)

Write in your answer below...

I am the Legal Guardian of any minors listed below.


Family Member #2 Full Name

Write in your answer below...

Family Member #3 Full Name

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Family Member #4 Full Name

Write in your answer below...

Family Member #5 Full Name

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Family Member #6 Full Name

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Emergency Contact Info


Emergency Contact Name

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Emergency Contact Phone

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What is the emergency contact's relationship to the minors?

Write in your answer below...

Agreement/Waiver


I have visited the Summer Break website and have read and agree to all the legal terms and conditions included on the Rock Wall Waiver and I agree to follow the Pool Rules.


By typing my name below, it will act as an electronic signature verifying that I am the parent or guardian to the listed minors on this form and I have read the online pool rules, rock wall waiver and COVID waiver and agree to the legal terms and conditions outlined for all people on this form for the entire pool season.

Write in your answer below...




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Summer Break Swim Club: 8376 E. 141st St, Fishers, IN 46038  |  Office Address: 4762 W. 1050 S., Pendleton, IN 46064



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