New Swimmer Information:
Swimmers Name
*
First Name
Last Name
Parents Name
First Name
Last Name
Parent's E-mail
example@example.com
Has this child been in swim lessons before? What brought you here to our Y?
If you are a returning swimmer, is there an instructor that your child has connected well in the past?
To help us identify swim goals for your child, please select any and all statements that are true for your child.
Able to follow verbal instructions
Comfortable in the water without a parent present
Comfortable with face and ears in the water
Able to swim short distances underwater in shallow water
Able to float on back for 15-30 seconds without a life jacket
Able to jump into deep water and return safely to a wall without a life jacket
Able to swim one length of the pool without flotation assistance
Able to swim one length of front crawl with some understanding of rotary breathing and one length of backstroke
Able to swim one length of Breaststroke
Able to swim one length of Butterfly
Does this child have any health, learning, or behavioral concerns that you would like the lifeguards and/or instructor to be made aware of? Please let us know if your child has any needs we can accommodate, such as tubes in ears, asthma, seizure disorders, autism, attention/focus issues, sensory processing concerns, etc.
Any additional information you'd like us to know?
Submit
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