Unsupervised Minor Guest Consent Form

Written consent is required for a guest who is a legal minor (age 17 and under) attending the pool as a guest of a member who is an unsupervised minor.

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Minor's Full Name(Required)
MM slash DD slash YYYY
Legal Guardian's Name(s)(Required)
Address(Required)
In case of an emergency, illness or accident to the above listed guest, pool management and/or River Mill staff members are authorized to contact the persons listed above. In case emergency attempts have been unsuccessful and it is necessary to take the child to the hospital, please specify preferred hospital:

Unsupervised Minor

The minor listed above is in my legal care and has my permission to swim as a guest at The River Mill pool without supervision. Legal guardians shall be liable for all minors left unsupervised at the pool (“Unsupervised Minors”) as it pertains to all state statutes. For guidance on who may be left unsupervised under the law, please consult section 2.4.2.2 of the Child & Family Services Manual detailing “Inadequate Supervision.” The above minor and legal guardian jointly accept all responsibility for the minor’s behavior and will ensure compliance with all of the pool rules and regulations of River Mill. It is also understood that the manager and/or lifeguards on duty are fully authorized to enforce all rules and regulations, and may temporarily suspend pool usage as they deem necessary. In case of an emergency, illness or accident to the above listed guest, pool management and/or River Mill staff members are authorized to contact the persons listed above.