Swim Verification Form


Verification of Channel Swim

 

Channel:   ___________________________________________________


Date:   ______________________________________________________


Swimmer’s Name:   ___________________________________________


Start Location:   ______________________________________________


End Location:   ______________________________________________


Start Time:  _________________________________________________


End Time:  __________________________________________________


Total Time of Swim:  _________________________________________

 
Boat Name:  _________________________________________________


Boat Captain’s Name, phone number and email address:  ____________________________________________________________

 
Observer(s) Name, phone number and email address:   ____________________________________________________________


I certify that  __________________________ swam from shore to shore, starting above the high water mark and finishing above the high water mark, did not receive flotation or propulsion support, and did not use swim aids other than goggles.

 
Send completed form to:        Linda Kaiser
                                               6158 Summer Street
                             Honolulu, Hawaii  96821

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