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Student Name Signed Certified Lifeguard/Swim Instructor Date of Test Phone No Email Address For larger rosters please duplicate this document. PSRA Swim Test 2017 Team/School Head Coach s Name The following student-athletes have passed a swim test that requires them to swim two laps of a regulation-size pool and tread water for five minutes wearing sweat pants and a sweat shirt or clothing equivalent in bulk and weight.

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