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Sussex Swim Specialists Enquiry Form
Please answer all questions, it should take no longer than 90 seconds
13
Questions
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1
How many swimmers are you looking to book on?
*
This field is required.
If more than 1, please fill in the best you can and we will discuss all options over the phone
One swimmer
Two swimmers
Three swimmers
Four or more swimmers
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2
Swimmers full name
*
This field is required.
First Name
Last Name
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3
Age of swimmer
*
This field is required.
Please Select
Under 3yrs
3yrs-4yrs
5yrs-8yrs
8yrs and above
Adult
Please Select
Under 3yrs
3yrs-4yrs
5yrs-8yrs
8yrs and above
Adult
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4
Ability of swimmer
*
This field is required.
To the best of your knowledge
Please Select
Never had swimming lessons
Never had swimming lessons, has a fear of the water
Happy swimming with flotation aids (floats, noddles, arm bands)
Can swim with flotation aids (floats, noodles, arm bands), but has a fear of water
Can swim 5m (independently)
Can swim 10m (independently)
Can swim 25m (independently)
Can swim 50+ (independently)
Please Select
Never had swimming lessons
Never had swimming lessons, has a fear of the water
Happy swimming with flotation aids (floats, noddles, arm bands)
Can swim with flotation aids (floats, noodles, arm bands), but has a fear of water
Can swim 5m (independently)
Can swim 10m (independently)
Can swim 25m (independently)
Can swim 50+ (independently)
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5
Does the swimmer require 1:1 lessons
*
This field is required.
YES
NO
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6
Does the swimmer have learning difficulties or diagnosed SEN, if so please tick the appropriate box/es
*
This field is required.
Autistic
ASD, PSD
ADHD
Sensory
Mute/ Selective mute
Downs syndrome
Not diagnosed, but suspected
None
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7
What is the closest venue to you?
Please Select
Angmering
Burgess Hill
Chichester
Cranleigh
Fontwell
Haywards Heath
Horley
Please Select
Angmering
Burgess Hill
Chichester
Cranleigh
Fontwell
Haywards Heath
Horley
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8
What is your end goal for swimming lessons?
*
This field is required.
Please Select
No specific distance but to conquer a fear of water
To feel confident and safe in the water
To swim 5m front and back (aided)
To swim 5m front and back (unaided)
To swim 10m front and back (unaided)
To swim 25m front and back (unaided)
To swim 50+ front and back (unaided)
To swim unaided across all 4 strokes 10m
No specific distance, but to improve technique in general
Please Select
No specific distance but to conquer a fear of water
To feel confident and safe in the water
To swim 5m front and back (aided)
To swim 5m front and back (unaided)
To swim 10m front and back (unaided)
To swim 25m front and back (unaided)
To swim 50+ front and back (unaided)
To swim unaided across all 4 strokes 10m
No specific distance, but to improve technique in general
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9
What is the best time of day to call?
*
This field is required.
0800-1000
1000-1200
1200-1400
1400-1600
1600-1800
1800-2000
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10
Parent/ Guardian name
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11
Contact details- email address
*
This field is required.
example@example.com
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12
Contact details- phone number
*
This field is required.
Area Code
Phone Number
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13
Advise from Olympic swimmer Rebecca Adlington
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