KIDS GROUP LESSON
SWIM LEVEL QUESTIONNAIRE AND CODE OF CONDUCT
Parent/Guardian Information
Name
*
First Name
Last Name
Primary Email Address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Residence Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which neighborhood do you live in?
*
Please Select
Avimor
Crossfield
Eagle Creek
My neighborhood is not listed
Emergency Contact 1
Name
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact 2
(Optional)
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
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Swimmer Information
How many kids do you want to enroll in Bob Swim Co? If you have more than one child you want to sign up for lessons more swim questionnaires will populate for you to fill out for each child.
1
2
3
4 or more
Child's Name
First Name
Last Name
Child's Age
Has your child had lessons before?
Yes, by another swim school
Yes, by Bob Swim Co
No
Can your child blow bubbles in the water?
Yes
No
Can your child comfortably put their face in the water for at least 5 seconds?
Yes
No
Can your child kick to the width of the pool with or without assistance?
Yes
No
Can your child swim across the width of the pool on their own breathing in front?
Yes
No
Can your child float on their back independently?
Yes
No
Can your child kick on their back with their arms extended?
Yes
No
Can your child swim front crawl/freestyle the width of the pool breathing to the side (cheek in the water)?
Yes
No
Can your child kick on their side with one arm extended?
Yes
No
Has your child been introduced to backstroke?
Yes
No
Can your child swim front crawl/freestyle the length of the pool (long ways) breathing to the side (cheek in the water)?
Yes
No
Has your child been introduced to breaststroke or butterfly?
Yes
No
Does your child understand why we position the body the way we do to float?
Yes
No
Total for Swimmer 1
What size Tshirt does your child wear? (Youth sizes)
XS
Small
Medium
Large
Is there anything else you think is important that we know to provide the most optimal lessons for your child? (Optional)
Medical Information
Please list any food or other allergies
Please list any other medical information you feel we should know about.
Welcome to Bob Swim Co Copper Team!
Welcome to Bob Swim Co Bronze Team!
Welcome to Bob Swim Silver Team!
Welcome to Bob Swim Co Gold Team!
Welcome to Bob Swim Co Platinum Team!
Welcome to Bob Swim Co Diamond Team!
Swimmer 2
Child's Name
First Name
Last Name
Child's Age
Has your child had lessons before?
Yes, by another swim school
Yes, by Bob Swim Co
No
Does your child know how to blow bubbles in the water?
Yes
No
Is your child comfortable putting their face in the water for at least 5 seconds?
Yes
No
Can your child kick to the width of the pool with or without assistance?
Yes
No
Can your child swim across the width of the pool on their own breathing in front?
Yes
No
Can your child float on their back independently?
Yes
No
Can your child kick on their back with their arms extended?
Yes
No
Can your child swim front crawl/freestyle the width of the pool breathing to the side (cheek in the water)?
Yes
No
Can your child kick on their side with one arm extended?
Yes
No
Has your child been introduced to backstroke?
Yes
No
Can your child swim front crawl/freestyle the length of the pool (long ways) breathing to the side (cheek in the water)?
Yes
No
Has your child been introduced to breaststroke or butterfly?
Yes
No
Does your child understand why we position the body the way we do to float?
Yes
No
Total for Swimmer 2
What size Tshirt does your child wear? (Youth sizes)
XS
Small
Medium
Large
Is there anything else you think is important that we know to provide the most optimal lessons for your child? (Optional)
Medical Information
Please list any food or other allergies
Please list any other medical information you feel we should know about.
Welcome to Bob Swim Co Copper Team!
Welcome to Bob Swim Co Bronze Team!
Welcome to Bob Swim Co Silver Team!
Welcome to Bob Swim Co Gold Team!
Welcome to Bob Swim Co Platinum Team!
Welcome to Bob Swim Co Diamond Team!
Swimmer 3
Child's Name
First Name
Last Name
Child's Age
Has your child had lessons before?
Yes, by another swim school
Yes, by Bob Swim Co
No
Does your child know how to blow bubbles in the water?
Yes
No
Is your child comfortable putting their face in the water for at least 5 seconds?
Yes
No
Can your child kick to the width of the pool with or without assistance?
Yes
No
Can your child swim across the width of the pool on their own breathing in front?
Yes
No
Can your child float on their back independently?
Yes
No
Can your child kick on their back with their arms extended?
Yes
No
Can your child swim front crawl/freestyle the width of the pool (short ways) breathing to the side (cheek in the water)?
Yes
No
Can your child kick on their side with one arm extended?
Yes
No
Has your child been introduced to backstroke?
Yes
No
Can your child swim front crawl/freestyle the length of the pool (long ways) breathing to the side (cheek in the water)?
Yes
No
Has your child been introduced to breaststroke or butterfly?
Yes
No
Does your child understand why we position the body the way we do to float?
Yes
No
Total for Swimmer 3
What size Tshirt does your child wear? (Youth sizes)
XS
Small
Medium
Large
Is there anything else you think is important that we know to provide the most optimal lessons for your child? (Optional)
Medical Information
Please list any food or other allergies
Please list any other medical information you feel we should know about.
Welcome to Bob Swim Co Copper Team!
Welcome to Bob Swim Co Bronze Team!
Welcome to Bob Swim Co Silver Team!
Welcome to Bob Swim Co Gold Team!
Welcome to Bob Swim Co Platinum Team!
Welcome to Bob Swim Co Diamond Team!
Swimmer 4
Child's Name
First Name
Last Name
Child's Age
Has your child had lessons before?
Yes, by another swim school
Yes, by Bob Swim Co
No
Does your child know how to blow bubbles in the water?
Yes
No
Is your child comfortable putting their face in the water for at least 5 seconds?
Yes
No
Can your child kick to the width of the pool with or without assistance?
Yes
No
Can your child swim across the width of the pool on their own breathing in front?
Yes
No
Can your child float on their back independently?
Yes
No
Can your child kick on their back with their arms extended?
Yes
No
Can your child swim front crawl/freestyle the width of the pool (short ways) breathing to the side (cheek in the water)?
Yes
No
Can your child kick on their side with one arm extended?
Yes
No
Has your child been introduced to backstroke?
Yes
No
Can your child swim front crawl/freestyle the length of the pool (long ways) breathing to the side (cheek in the water)?
Yes
No
Has your child been introduced to breaststroke or butterfly?
Yes
No
Does your child understand why we position the body the way we do to float?
Yes
No
Total for Swimmer 4
What size Tshirt does your child wear? (Youth sizes)
XS
Small
Medium
Large
Is there anything else you think is important that we know to provide the most optimal lessons for your child? (Optional)
Medical Information
Please list any food or other allergies
Please list any other medical information you feel we should know about.
Welcome to Bob Swim Co Copper Team!
Welcome to Bob Swim Co Bronze Team!
Welcome to Bob Swim Co Silver Team!
Welcome to Bob Swim Co Gold Team!
Welcome to Bob Swim Co Platinum Team!
Welcome to Bob Swim Co Diamond Team!
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Parent/Guardian Signature
Please review and sign the following documents
General Liability Waiver
Code of Conduct
Please verify that you are human
*
Submit
Should be Empty: