Junior Preliminary Skills Evaluation Form - 2021-22

It is a requirement of Life Saving Victoria (LSV) that all Nippers complete a Preliminary Skills Evaluation prior to participating in any water-based activities at our club. These assessments can be completed either in a swimming pool or in open water. The below competency is required to be completed by one of the below assessors.

Assessors

AUSTSWIM or equivalent Teacher of Swimming & Water Safety, Foundation Coach, Performance Coach, Development Coach, Core Official, Technical Official, Senior Official, Performance Official, Training Officer (SRC/Bronze), Assessor (SRC/Bronze), Age Manager Presenter.
Please complete this form by 10th Dec 2021 to allow adequate time for processing with LSV.

Important:
- Nippers cannot participate in water activities unless this form has been completed and returned to the club.
- Each child must have their own form.
- This form must be accurately completed. Please ensure that the correct Age Group for your child is selected based on their DOB.
NIPPER DETAILS
Name*
First Last
Date of Birth*

Day
Month
Year
AGE GROUP
Age Group*
Please select the Age Group of your child. The requirements for each Age Group are listed below (click to show).
- U6 (Born 1 Oct 2015 – 30 Sept 2016)
- U7 (Born 1 Oct 2014 – 30 Sept 2015)
- U8 (Born 1 Oct 2013 – 30 Sept 2014)
- U9 (Born 1 Oct 2012 – 30 Sept 2013)
- U10 (Born 1 Oct 2011 – 30 Sept 2012)
- U11 (Born 1 Oct 2010 – 30 Sept 2011)
- U12 (Born 1 Oct 2009 – 30 Sept 2010)
- U13 (Born 1 Oct 2008 – 30 Sept 2009)
- U14 / SRC (Born 1 Oct 2007 – 30 Sept 2008)
- Bronze Medallion
Age Group Skill Requirements
- Select to show the Skill Requirements for each Age Group
U6 (Born 1 Oct 2015 – 30 Sept 2016)

Swim Requirement: From a standing position in waist deep water perform a front glide and recover to a secure position.
Float Requirement: Perform a back float for 15 seconds whilst holding a buoyant aid and recover to a secure position.

U7 (Born 1 Oct 2014 – 30 Sept 2015)

Swim Requirement: From a standing position in waist deep water perform a front glide, kick for 3m and recover to a secure position.
Float Requirement: Perform a back float for 30 seconds and recover to a secure position.

U8 (Born 1 Oct 2013 – 30 Sept 2014

Swim Requirement: 25 metre swim (any stroke)
Float Requirement: 1 minute survival float (on back)

U9 (Born 1 Oct 2012 – 30 Sept 2013)

Swim Requirement: 25 metre swim (any stroke)
Float Requirement: 1 minute survival float (on back)

U10 (Born 1 Oct 2011 – 30 Sept 2012)

Swim Requirement: 25 metre swim (freestyle/front crawl)
Float Requirement: 1½ minute survival float (on back)

U11 (Born 1 Oct 2010 – 30 Sept 2011)

Swim Requirement: 50 metre swim (freestyle/front crawl)
Float Requirement: 2 minute survival float (on back)

U12 (Born 1 Oct 2009 – 30 Sept 2010)

Swim Requirement: 100 metre swim (freestyle/front crawl)
Float Requirement: 2 minute survival float (on back)

U13 (Born 1 Oct 2008 – 30 Sept 2009)

Swim Requirement: 150 metre swim (freestyle/front crawl)
Float Requirement: 3 minute survival float (on back)

U14 / SRC (Born 1 Oct 2007 – 30 Sept 2008)

Swim Requirement: 200 metre swim (freestyle/front crawl within 5 minutes)
Float Requirement: 3 minute survival float (on back)

Bronze Medallion

Swim Requirement: 400 metre swim (within 9 minutes)
PARENT DETAILS
Name*
First Last
Email
SIGN-OFF
Confirmation of Evaluation*
- I confirm this child from Fairhaven SLSC has completed the swim and survival float requirements for their age group competently.
Name of Assessor*
First Last
Qualification / Position*
Signature*
Date*

Day
Month
Year
Captcha

FAIRHAVEN SURF LIFE SAVING CLUB

Junior Preliminary Skills Evaluation Form – 2021-22

NIPPER DETAILS

AGE GROUP

PARENT DETAILS

SIGN-OFF