CHSLS Pre-Season Swim Proficiency

Pre Season Pool Proficiency

To be completed prior to season commencement
Pool Proficiency being done by

Accredited Swim Instructor (eg SwimAus, AustSwim)CHSLSC - Accredited Surf Coach or Trainer
NIPPER INFORMATION:
Season

DayMonthYear
Date
Member ID (if known)
7 Digit Number
Nipper Member Name as per Registraion*

First NameLast Name
Birth Date*

DayMonthYear
Age Group
Auto-calculated
For example, if your child was 11 on the 30th September (turning 12 on the 5th Oct) they will be in the Under 12 age group (even though they are 12).
Gender*
Pull Down
PARENT/GUARDIAN INFORMATION:
CHSLSC Registered Parent/Guardian 1 Name*

First NameLast Name
Mobile Number*
E-mail*
example@example.com
POOL PROFICIENCY

The junior member must be able to:
U08 25m Any Stroke Maximum Time none
Float for 5 seconds, recover to stand.
Submerge to touch the bottom with hands
Swim under water for 2-3 meters
U09 100m Freestyle Maximum Time 3:30
Tread water/ sculling for 2 minute
Retrieve object from the bottom of the pool
U10 100m Freestyle Maximum Time 3:30
Tread water/ sculling for 3 mins
Retrieve object from the bottom of the pool
U11 150m Freestyle Maximum Time 5:00
Tread water/ sculling for 4 mins
Retrieve object from the bottom of the pool
U12 150m Freestyle Maximum Time 5:00
Tread water/ sculling for 5 mins
Retrieve object from the bottom of the pool
U13 200m Freestyle Maximum Time 5:00
Tread water/ sculling for 6 mins
Retrieve object from the bottom of the pool
U14 200m Freestyle Maximum Time 5:00
Assessor / Swimming Instructor Section
Assessor / Swimming Instructor*

First NameLast Name
Accreditation ID Number*
Actual Time Taken to complete the above swim*
mm:ss
Additional Notes or Observations
I have observed the swimmer & confirm the swimmer has undertaken the tasks competently and has completed the required swim.
Swimming Instructor Signature: *

Clear
Should be Empty:

Pre Season Pool Proficiency

NIPPER INFORMATION:

PARENT/GUARDIAN INFORMATION:

POOL PROFICIENCY

Assessor / Swimming Instructor Section