| Today's Date | 03/27/2026 |
|---|---|
| Patch Test Description | Test Requirements 1) Swim the length of the pool with a competent stroke; 2) Tread water for one minute; and 3) Float on their back for 15 seconds. |
| Child's Information | |
| DLSC Number | 900 |
| Child's Name | William Test |
| Date of Birth | 03/12/2026 |
| Parent Information and Permission | |
| Parent's Name | Mart Test |
| Phone | (444) 444-4444 |
| Email hidden; Javascript is required. | |
| Parent's Signature | |
| DLSC Guard and Manager Information | |
| Guard who gave the Patch Test | John Guard |
| Manager who oversaw the Patch Test | Alice Manager |
| Guard's Signature |