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This page can be printed and sent to the address listed at the bottom.

If you have any questions please call  

West Chester Community Administrators 

513-860-3120

                   Waiver for 14 and 15 year old pool use 

 This waiver allows and unaccompanied 14-15 year old minor to use the pool once the 
child has read and understood the rules of the pool as adopted by the Lake Princeton 
Board of Directors. This waiver must be signed by the parent and the child, This form 
will be kept on file with West Chester Community Administrators 

Name of Homeowner_________________________________________________ 

Address ____________________________________________________________ 

Child's Name ________________________________________________________ 

Child's Age _____________ 

"I, as the parent or guardian of the above named child, accept full responsibility for 

 the above named child, to use the pool, and have ensured that the child has read and 

understands the pool rules and regulations. I understand that there sill be NO 

 lifeguard or pool attendant on duty, so there is no one there to baby-sit them, it will 

be up to them to conduct themselves in an acceptable manner. I also understand that 

They may bring only one guest with the." 

Signature of Parent:______________________________________ 

Signature of Child:_______________________________________ 

Date:_________________________ 

This form can be dropped off at our mailed to my office at 

Lake Princeton 

9772 Princeton-Glendale Road 

Suite 4 

Cincinnati, Ohio 45246     
Fax number 513-860-3190 

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