Harris County Adult Aquatics Program Physician'S Release Form printable pdf download

Harris County Adult Aquatics Program Physician'S Release Form

Harris County Adult Aquatics Program

Physician’s Release Form

The Harris County Adult Aquatics Program offers swimming lessons, lap swimming, water aerobics, and aqua zumba

classes. Some of these activities may result in an increased heart rate. These are fitness classes but they are

designed for recreational purposes only.

Swim Lessons – Teaches participants the fundamentals of swimming with an overall goal of learning how to swim

correctly along with basic water survival skills.

Lap Swimming – Allows participants to use the pool to swim continuous laps. Participants are required to pass a

swimming test.

Water Aerobics – low impact, high cardio exercises.

Aqua Zumba – low impact, high cardio exercises.

Physician’s Permission to Participate Statement

I have reviewed the classes and activities associated with the Harris County Adult Aquatics Program and I hereby

give permission for __________________________________________________ whose address is

_________________________________________ for participation in the program described above.

Restrictions if any:

Signed this _______________ day of _____________________________________, 20___.

____________________________________________

______________________________________________

Physician’s Signature

Address

____________________________________________

______________________________________________

Printed Name and Title

Phone and Fax

Participant’s Authorization and Release

I hereby authorize my doctor to execute the above form, which allows my participation in the Harris County Adult

Aquatic Program.

_______________________________________________

________________

Participant’s Signature

Date

Harris County Adult Aquatics Program Physician'S Release Form