Verification Form

Verification of Channel Swim

 

Channel Name:  _________________________________________________________________

 

Swimmer’s Name(s):  _____________________________________________________________

 

Start Location:  _________________________________  Start Date and Time:  _______________

 

End Location:  __________________________________  End Date and Time:  ________________

 

Total Time of Swim:  ________________________________

 

Boat Name:  _______________________________________

 

Boat Captain’s Printed Name:  _________________________  Signature:  ___________________

 

Phone/Email:  ______________________________________

 

Observer’s Name:  _________________________________  Signature:  ____________________

 

Phone/Email:  ______________________________________

 

I certify that __________________________ swam from shore to shore, starting 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:       Bill Goding, 92-1974 Kulihi St, Kapolei, HI  96707      (808) 221-0216

                                                                        Or

Scan form and email to:         roscoe@hawaii.rr.com

Once the form is received, the swim will be verified and recorded.  The swimmer's name

will be posted on the Hawaii Channel Association, the Ka'iwi Channel Association and the Molokai Channel Swimmers Association websites.