Form - Section NE-3A

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As a unit or lodge leader of the above named participant, I hereby attest that the named participant has passed the BSA.
2017 Conclave “Participant Can Swim” Form This form is required for ALL participants under 18 years of age

Participant Name: _________________________________________________________________ Date: __________ Address/City/State/Zip:_____________________________________________________________________________ Home Phone:____________________________________

Alternate Phone:_________________________________

As a unit or lodge leader of the above named participant, I hereby attest that the named participant has passed the BSA Swimmer’s test as outlined here: Jump feet-first into water over the head in depth, level off, and begin swimming. Swim 75 yards in a strong manner using one or more of the following strokes: sidestroke, breaststroke, trudgen, or crawl; then swim 25 yards using an easy resting backstroke. The 100 yards must be swum continuously and include at least one sharp turn. After completing the swim, rest by floating.

____________________________________________ Leader Signature

____________________________________________ Participant Signature

____________________________________________ PRINTED Name

____________________________________________ PRINTED Name

____________________________________________ Date Signed

____________________________________________ Date Signed

PARTICIPANTS MUST HAVE THIS COMPLETED AND SIGNED FORM IN THEIR POSSESSION TO PARTICIPATE IN AQUATIC ACTIVITIES