412-343-1661  |    kids@mledp.org

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Child's Name

MLEDP Summer Fun follows the Mt. Lebanon Swim Center Guidelines for swimming, diving and use of the water slide. MLEDP reserves the right to limit activity at the pool if a child’s behavior endangers them or another child. Each family is responsible for the purchase of a pool pass or swimming tickets for their child. These may be purchased through the Mt. Lebanon Recreation Department. Parents, please complete the releases below for the level of activity permissible for your child.

Please note: MLEDP is providing child care in a group setting and reserves the right to set grade requirements for some pool activities, to ensure safe group management at the pool

Deep Water, Slides, Climbing Wall and Diving Board Permission

To swim in deep water and use the slides, climbing wall and diving board, your child must have completed Grade 2 or above and pass the Swim Center’s test in addition to you giving permission.

I give permission for my child to do the following: Swim in Deep Water, Use the Diving Board, Use the Slides and Use the Climbing Wall.


Sunscreen is considered a medication, requiring parents permission to be given.

DHS will now permit communal sunscreen for the children.  This will enable the staff to carry a small supply for reapplication at the pool instead of carrying individual bottles for each child. 


Parents will supply sunscreen.


Parents may supply sunscreen to be used for their child only, if there is an allergy or sensitivity preventing the child from using communal sunscreen.  


Staff will dispense the sunscreen and oversee the application.

Do you give permission for the application of sunscreen on your child?
Do you give permission for your child to participate in the use of communal Sun Screen?