Unlock Your Fearless Swimming Application

Unlock Your Fearless Swimmer Application

Please answer all questions to the best of your ability. We only consider candidates who take this process seriously so we can understand how best to serve and support you.
Full Name*

First NameLast Name
Phone*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Understanding Your Background:
What factors have contributed to your current inability to swim? Please Include: Family history of swimming avoidance. Traumatic experiences (please describe in detail). Failed attempts in childhood or adulthood. Other contributing factors (please explain)*
Have you had any near-drowning experiences or witnessed one? If yes, please describe:*
Have you ever avoided water-based activities (e.g., pools, beaches, boating)? Please describe:*
Do you have any health conditions or physical limitations that could affect your ability to learn to swim? Please describe:*
Present Day Fear and Emotions:
How does your fear manifest? (Check all that apply)*

Ruminating thoughtsSleepless nightsFight/flight/freeze responseMuscle tensionUpset stomach/nauseaTrembling/shakingRapid heartbeatOther
When does your fear tend to show up? (Check all that apply)*

At the thought of swimmingUpon arriving at the pool or water environmentEntering the waterWhen my face gets wet [in a pool or shower]when unable to touch the bottomWhen I cannot get a new breathOther
Rate your current level of fear about swimming on a scale of 1–10: (1 = no fear, 10 = extreme fear)
Previous Attempts & Learning History:
Please describe in details any prior attempts [from childhood onward] learning to swim? Please describe: In-person private lessons. Group classes (class size and instructor experience). Virtual lessons. Self-teaching. Other (please describe)*
Why do you believe previous attempts did not work for you?*
What has been your biggest obstacle to progress in past attempts?*
Why Now?:
Why is now the right time for you to learn to swim? Please describe all that apply: Personal goals. Upcoming events (e.g., vacations, family activities). Recent traumatic or embarrassing experiences. Emotional or psychological breakthroughs. Other motivations*
What are your goals for this retreat?*
What will your life look like after learning to swim?*
Commitment Level:
Can you commit to completing one week of pre-requisite activities? (Failure to complete these will void your retreat guarantee) *
Can you commit to 20–25 hours of in-water activity during the retreat?*
What obstacles might prevent you from fully participating in the retreat?*
Investment & Financial Readiness:
Our 6-Day Retreat tuition is $1999 (excludes airfare, lodging, and food). Is this within your budget?*
Would you prefer a flexible payment plan? (Deposit $750, 2x monthly payments of $750 totaling $2250)*
What additional financial considerations (if any) do you have?*
Likelihood Of Success:
What makes you believe you will succeed in this program?*
Have you successfully completed other fear-based challenges? (Please describe and include details on your approach to overcoming them.)*
Are you willing to adopt a beginner’s mindset and embrace relaxed exposure techniques? Please describe:*
What support systems or personal habits will help you succeed during this retreat?*
Questions For Caribe Swim:
What specific questions do you have about the retreat?*
What concerns or hesitations (if any) do you have about joining this retreat?*
Should be Empty:

Unlock Your Fearless Swimmer Application

Understanding Your Background:

Present Day Fear and Emotions:

Previous Attempts & Learning History:

Why Now?:

Commitment Level:

Investment & Financial Readiness:

Likelihood Of Success:

Questions For Caribe Swim: