Swim Test Form We must have certification that your child/student is capable of swimming at our required competency by Wednesday June 15th. If your child is in the process of completing a swim program, we must have one of these forms here before their first day or they will not be able to participate in any Courageous Sailing course. All Youth Program sailors be able to swim 75 feet and tread water for 90 seconds. Acceptable Proof of Swimming Capability: - YMCA: Certification of completion of Pollywog level or above, or Red Cross: Certificate of Completion for Level V or above, or Boy/Girl Scouts: Swimming or Lifesaving Badge, or A letter stating swimming ability at or above our required level on pool letterhead, or This form, completed below. To submit this form, please: 1. Clearly print the student’s full name below, 2. Have a certified Lifeguard/Water Safety Instructor observe the student and complete the form below, 3. Make a copy of the proof of swimming (or this sheet) for your records, and 4. Mail or drop off by Wednesday June 15, 2011 to the address at right Attn: Kate Henderson Courageous Sailing One First Avenue Boston, MA 02129 Name of Student/Sailor: ________________________________________________________________________ Name of Lifeguard/Water Safety Instructor: ____________________________________________________ Name of Pool or Pool Organization: ____________________________________________________________ City and State Pool is located:___________________________________________________________________ Pool telephone number: ________________________________________________________________________ I hereby certify that the student can swim 25 yards in a competent manner and can remain afloat/tread water for at least 90 seconds. Date of Test: ______________________ Signature of Lifeguard/Water Safety Instructor___________________________________________________ Printed name of Lifeguard/Water Safety Instructor:______________________________________________ Please keep a copy of this completed swim test for your records.
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