Contact Info

Family Information

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

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I am the Legal Guardian of any minors listed below.

Family Member #2 Full Name

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Family Member #3 Full Name

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Family Member #4 Full Name

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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?

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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 and rock wall waiver and agree to the legal terms and conditions outlined for all people on this form for the entire pool season.

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