Swim Test Form - Courageous Sailing

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.