SWIM TEST EVALUATION

YMCA OF SOUTH HAMPTON ROADS

Child Name (Print): _________________________________________________________________________________________________________________

Age: ____________________ Date of Birth: __________________________ Male Female

I have read and understand the pool rules and guidelines

Phone Number: _____________________________________________________

Parent Name (Print): _______________________________________________ Parent Signature: _______________________________________

Front Crawl

WHO IS THE SWIM TEST FOR? Front crawl: _______________________________________________________________________________________________

Children between the ages of 5 and 12
may take the swim test. Upon successful
completion of the swim test, your child will be
given a neckband they will need to wear each
time they come to a YMCA Family Center to
swim. When a child completes the swim test,
a record of this information will be updated
weekly in our computer system. If your child’s
swim neckband is lost, you may replace it
at membership services for $2, once per
year. If your swim neckband breaks you may
exchange it for a new one at no cost. The
swim test may be taken once per day. If your
child is not successful, then they must stay
within arms reach of an adult and follow all
rules for a non-swimmer.
Arms out of water, basic breathing skills, swimming horizontal in the water OR Breaststroke
Breaststroke: ____________________________________________________________________________________________
Symmetrical arm and leg kick, basic breathing skills, horizontal in the water
Tread water for 30 seconds: ___________________________________________________________________________
Head, chin, and ears must stay out of water, vertical body position Climb
Out
Climb out of pool: ________________________________________________________________________________________
Able to exit swimming pool by steps, ladder or side
Jump in deep end: _______________________________________________________________________________________
Able to jump in feet first and resurface; face must get wet
_______________ Successful _______________ Unsuccessful
Evaluator: _______________________________________________ Date: ______________________________________
Family Center: _________________________________________________________________________________________

FOR OFFICE USE ONLY

Add message type “Swim test” to member’s account, with name and test date. Set message to expire on 12/31 of this year.

Information updated and/or entered into SGA Employee Signature: _________________________________________________________________________

May 2023
SWIM SAFE
Pool Guidelines
1. YMCA swimming pools are only
to be used when a lifeguard is
on duty.
2. Children (9 years and younger)
must be supervised by a parent/
guardian (16 years or older) at
all times.
3. Non swimmers must be within
arm’s reach of a parent or
supervising guardian at all
times and in water 5 ft or less.
One parent/ guardian may
supervise a maximum of three
non-swimmers.
4. Only Coast Guard approved
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as a means of support for
nonswimmers.
5. Children ages 10–12 may
use the pool only under the
supervision of someone 16
years or older who is on the Y’s
premises and the child has
completed the requirements of
the YMCA of South Hampton
Roads Swim Test. Please refer to
the member guide for all age
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6. Please shower before entering
the swimming pool.
YMCA management may close the pool at any time to ensure the safety of patrons. All
pools will be closed for at least 30 minutes when lightning and/or thunder is observed.
7. Persons with open cuts, sores or 14. Chewing gum, tobacco
blisters are not permitted in the products(including e-cigarettes)
swimming pool. and alcohol aren’t permitted in
the Y’s aquatic environments.
8. Children who are not potty-
trained must wear reusable swim 15. Fins and snorkels, and
diaper or disposable swim diaper kickboards are only permitted
with a cover or swimsuit. Plastic in lap lanes or during a YMCA
covers are available for purchase program.
at the membership desk.
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9. Please use appropriate changing not permitted.
facilities (on-deck changing of
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any age is prohibited).
spins or back dives are not
10. Swimmers must wear permitted from the side of the
appropriate swimwear (no jeans pool. Diving from the side is
or cut-offs; swimsuits only). The permitted in swimming pools
Y asks all members to remember with a minimum of 9’ of water.
the family environment and
18. Running, horse playing, pushing,
choose the style of your
carrying people on shoulders
swimsuit accordingly.
or dunking is prohibited in the
11. Prolonged underwater swimming pool or deck area.
swimming or breath holding
19. When the whistle blows, look at
(More than 10s or 20m/y)
lifeguard immediately!
and hyperventilation is not
permitted. 20. Any act deemed unsafe by the
lifeguard or management will not
12. Hanging on lane lines, safety
be tolerated
ropes and basketball hoops is
not permitted.
13. Glass objects are not permitted
in the pool area and any food
consumed must be at least 10’
from the edge of the swimming
pool and in the designated area.