2017 Pool Waiver

THE HIGHLANDS POOL FACILITY

2016 POOL SEASON

WAIVER OF LIABILITY

for

CHILDREN 11 YEARS OF AGE THROUGH 15 YEARS OF AGE

I understand that The Highlands Pool Facility will allow my child(children) between the

age(s) of 11 and 15 use the pool without parent or guardian supervision; however, the life

guard may, at his/her discretion require a swim test to determine if the child can swim

well enough to use the pool without supervision.

I understand that The Highlands Community Association, The Highlands LLC, Golf

Connection, LLC, Touchstone Development, LLC, Touchstone II, LLC and Nash

Road/Woodpecker Road, LLC and their assigns assume no responsibility or liability for

my child(children). They use the pool at their own risk with my permission.

Children with this privilege must be able to swim the length of the pool without

assistance, must exhibit appropriate behavior, must follow the Pool Rules, and listen to

the instruction of the lifeguards or their waiver privileges can be revoked.

I give permission for my child(children) between the age(s) of 11 and 15 to use the pool

unsupervised and I assume all responsibility and liability for same.

________________________________________ __________________________

PARENT DATE

________________________________________ ___________________________

PARENT DATE

________________________________________ _____________________________

Day/Cellular/Work Telephone Numbers-required Home Telephone Number-required

Name of Child ___________________________________ Date of Birth___________

Name of Child ___________________________________ Date of Birth ___________

Name of Child ___________________________________ Date of Birth ___________

Parent(s) signature must be on file in order for unsupervised child to use the pool.

A NEW FORM MUST BE COMPLETED FOR THE 2016 POOL SEASON.