Swim Test Results And Swim Test Results Form Page 2
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1
2Swim Test Results
All tests must be supervised and administered by a Lifeguard with current Certification. A copy of their certification must
accompany this form. Incomplete forms, or absence of certification, will result in a retest at camp. The Waterfront Director
may review or re-test any Scout whose skills appear to be inconsistent with his classification. All principles of Safe Swim
Defense must be followed at the time of the test, including Adult Leadership. Please use additional forms for more Scouts.
Swim Classification
Full Name
(please print clearly)
Non-Swimmer
Beginner
Swimmer
I attest to the validity of the preceding information as a certified lifeguard. A copy of my certification is attached. I understand that
classifying an unqualified Scout as a swimmer, or beginner could endanger the health and safety of the individual and others.
Unit #: _______ Council: ______________________ Period at Camp: Ο 1
Ο 2
Ο 3
Ο 4
Ο 5
Ο 6
Ο 7
Ο 8
Unit Leader _____________________________
Pool Name & Location: ___________________________________
Lifeguard Name: __________________________
Signature: ___________________________ Date: ____/____/____
**Form invalid without attachment of a COPY of Certification Card**
Please mail, fax, or email this form and certification attachment to Samoset Council
3511 Camp Phillips Road, Weston WI 54476 | 715-355-9849 (fax) |
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