Swim Enrollment Form - Fireside
After you fill out this order enrollment form, we will contact you to go over details and availability before your lessons are booked and payment is taken. If you would like faster service and direct information please contact us at (480) 994-5437 or
Are you a new or existing customer?
I am a new customer
I am an existing customer
How did you hear about Kidtastics?
Child's First & Last Name
6 months - 1 year
What is your child’s experience in the water?
Other medical concerns?
Child's Special Interest/ Favorite Things (ex. toys, sports, shows, books, games, music) This allows use to get to know your child better to form trust.
Child's Fears/ Dislikes
Do you have any behavioral strategies or positive reinforcers that you would like to share?
What goals do you have for your child’s swim lesson?
Communication information for Children with autism (click all that apply)
Uses visual schedule
Can follow written instructions
Uses sign language
Can follow simple verbal instructions
Any things else we should know about your child?
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