1:1 Swim 2025 Winter Session 
Please complete the form below. Slots will be communicated to families by January 6th, and lessons will begin January 14th and 15th. 
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Swimmer's Name *
Date of Birth *
MM
/
DD
/
YYYY
Swimmer's primary diagnosis *
Best email for communication *
Swimmer's communication style  *
Required
Learning Style *
Required
Goal 1 for lessons *
Goal 2 for lessons *
Goal 3 for lessons *
Likes  *
Dislikes *
Calming strategies used at home *
Previous swimming lesson experience  *
What helped to make the lesson easier for your child?
In order to gather additional information to meet your member's needs, please check off all that apply. 
Touch 
Noise
Is there any additional information you would like to share that would help us meet your member's needs? *
Swim Slot Preferences
Preference 1 and 2 cannot be the same. Younger swimmers will be given priority for the earlier slots. If your child is already a competent swimmer, please consider one of our other swim opportunities at BGCD. This program's goal is to introduce members to the water, promote water safety, learn basic swim skills, and build confidence in/around water. 
Preference #1 *
Preference #2 - Please do not select same time slot as preference #1 *
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