Current Special Needs Swimmer Update!
Our mission is to allow children 3-11 years old with special needs to have fun while acquiring water safety and basic swimming skills. HFSS wants to ensure we have the most recent and up-to-date information on your swimmer. Please take a moment to fill out this for your swimmer. We will then add it to your swimmer's profile for our team to view.
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SWIMMER'S BASIC INFO
Swim Location
*
Please Select
Phoenix (32nd St & Thunderbird Rd)
Peoria (84th Ave & Thunderbird Rd)
Riverview (Loops 202 & Dobson Rd)
Goodyear (Pebble Creek Pkwy & McDowell Rd)
Swimmer's Name
*
First Name
Last Name
Gender
*
Please Select
Female
Male
Current Age
*
Available for children 3 up to 12 years old
Preferred Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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MEDICAL INFORMATION
Social / Developmental Age
*
Is your child toilet trained?
*
Yes
No- we require a reusable cloth swim diaper
On location up to a 4T is available to purchase. 5T and larger swim briefs can be purchased at www.theraquatics.com
Does your child aspirate
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Yes
No
Is your child on thickened liquids?
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Yes
No
Diagnosis Information
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Any physical limitations we should be aware of?
*
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COMMUNICATION INFORMATION
Communication
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Verbal
Limited Verbal
Non-Verbal
Sign-Language
Speech Device
Other - please detail below
Additional communication information.
*
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BEHAVIORAL INFORMATION
Does your child have aggressive behavior? Ex: Biting, pinching, hitting, etc.
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Yes
No
Please elaborate on your child's behavioral needs.
*
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CHILD INFORMATION
Special interests or favorite things?
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Fears or dislikes?
*
Positive Reinforcement Techniques
*
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SWIM EXPERIENCE
What goals do you have for your child in this program? Anything else you would like us to know about your child?
*
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PLEASE NOTE
We are unable to offer makeups to swimmers who have special accommodations in place because we cannot replicate those specific accommodations.
*
Yes. I understand my swimmer will not be eligible for makeup lessons or financial credit if I miss my class.
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