Swim Classification Form - Northern Tier printable pdf download

Swim Classification Form - Northern Tier

NORTHERN TIER HIGH ADVENTURE BASES

SWIM CLASSIFICATION RECORD

This form indicates the individual’s swim classification as of the date listed below. The date the swim

test was conducted must be within 12 months of the starting date of your expedition.

Crew Number ________________________________________ Date of Swim Test _______________

The following crew members (including adults) have all passed the test indicated on the next page and are classified as “Swimmers”

Full Name (print)

Name of Person Conducting Test (print) _____________________________________________________________

Signature of Person Conducting Test _______________________________________________________________

Qualification of Person Conducting Test:

__ Aquatics Instructor, BSA

__ Cub Scout Aquatics Supervisor

__ BSA Lifeguard

__ Certified Lifeguard

__ Swimming Instructor

__ Swim Coach

__ Adult supervisor who is familiar with the basic swimming strokes and abides by the guidelines in the Aquatics

Supervision manual

Unit Leader or Contingent Leader Name (print) _______________________________________________________

Unit Leader or Contingent Leader Signature __________________________________________________________

This record is to be presented at check-in at Northern Tier. It must be filled out and signed at

the time of the swim classification testing.

Updated 9/1/13 MBR

Swim Classification Form - Northern Tier