Proud to Serve the Communities of Annsville, Ava, Blossvale, Camden, Floyd, Lee Center, McConnellsville, New London, North Bay, Rome, Sylvan Beach, Taberg, Verona, Verona Beach, Westdale, and Westernville.




 







 

Instructor's Corner!

This page has been created so that the Health and Safety Instructor's have a chance to get valuable forms and the news that may be relevent to all of the instructor's or may be of some help to the instructor's.


The Forms and Reports can be sent to the office in a variety of ways.

  1. Drop them off at the office
  2. Mail them to the office: 303 West Liberty Street, Rome, NY 13440
  3. E-mail them to Devin McDonald, Health & Safety Coordinator:
  4. Fax them to the office: (315) 336-0032
General Instructor Forms

Instructor Agreement and Code of Conduct
Instructor Hierarchy

Course Record Form

Course Addendum Form
Directions on how to use the Course Record and Addendum

Leader Forms

Leader Agreement and Code of Conduct
First Aid and Preparedness Leader Activity Report

Lay Responder First Aid/CPR/AED Forms

Lay Responder Activity Report

Lay Responder Addendum

CPR/AED for the Professional Rescuer Forms

CPR/AED for the Professional Rescuer Activity Report

CPR/AED for the Professional Rescuer Addendum

Lifeguard Training Forms

Lifeguard Training Activity Report

Lifeguard Training Addendum

Water Safety Forms
(Please note this program is being revised Spring '09)

Water Safety Activity Report
Water Safety Addendum

Level 1-Introduction to Water Skills
 (pdf)
Level 2-Fundamental Aquatic Skills (pdf)
Level 3-Stroke Development (pdf)
Level 4-Stroke Improvement (pdf)
Level 5-Stroke Refinement (pdf)
Level 6-Fundamentals of Diving (pdf)
Level 6-Fitness Swimmer (pdf)
Level 6-Lifeguard Readiness (pdf)
Level 6-Personal Water Safety (pdf)

Water Safety Activity Report r.09
Water Safety Addendum r.09