Swimming Assessment Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

There are no wrong answers. Your honesty will help us help you. Classmates will not see your respondes.

What is your name? *

Personal Concerns: Please mark any personal concerns you may have about being in and around bodies of water *

How I look in a swim suit

Getting my hair wet

I don't know how to swim

I am afraid of the water

I will be forced to try something I am not comfortable doing

I can't breathe underwater and worry about water in my nose

Opening my eyes in the water

Others will tease me if I cannot complete the skill asked of me

Others know how to swim better than me

Not feeling safe in the water with other students around

I will drown because I don't know how to swim

Required

Water Comfortability: Please select one answer that best describes your comfortability in water *

I am completely terrified of getting into a pool

I will get into a pool but only the shallow end where I know I can touch the bottom

I will get into a pool and will go into water up to my neck but not the deep end of the pool where I cannot touch the bottom

I will get into a pool and will go in the shallow end and the deep end of the pool and feel comfortable and in control in the deep end

Required

Safety: Select all that you think is true *

I should ask permission from an adult before entering a body of water

Every pool is different from size, depth, lifeguards, and rules

Swimming at the beach, in a lake/pond, in a river is the same as swimming in a pool

I should swim only with supervision of an adult present

Bodies of water are all around Charleston, Dorchester, and Berkeley Counties

Large bodies of water can be fun yet dangerous at the same time

Lifeguards will always be present when I go swimming

It's never too late to learn how to swim

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report