Swimming Ability
Student's Name
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Year Group
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Please Select
Y1
Y2
Y3
Y4
Y5
Y6
Y7
Y8
Y9
Y10
Y11
Y12
Y13
Please tick all comments that are relevant to your child’s swimming ability.
Yes
Has never been in a swimming pool
Cannot swim but doesn't mind head underwater
Needs swimming aids such as armbands or floats
Is confident in the swimming pool
Can float on their front
Can float on their back
Can jump in from the side allowing their head to go under the water
Can swim 10 m without swimming aids
Can put head in the water and blow bubbles underwater
Shows some basic stroke technique
Is confident in deep water
Will jump confidently into the deep end of the swimming pool
Can swim 25 m without stopping
Demonstrates some technique in backstroke
Demonstrates some technique in breaststroke
Demonstrates some technique in freestyle
Can dive
Can swim more than 25 m
Demonstrates excellent technique in backstroke
Demonstrates excellent technique in breaststroke
Demonstrates excellent technique in freestyle
Can swim butterfly
Can swim underwater
Has had competition experience
Please give details of any swimming awards/certificates already achieved:
Confirmation
Parent or Guardian
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First Name
Last Name
Date
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Day
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Month
Year
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Signature of Parent or Guardian (valid as paper and pen signature)
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