Adult Learn to Swim and Adaptive Swimming Survey
Adult Learn to Swim and Adaptive Swimming
Are You?

Age: 18 years old or older

Swimming Abilities:
• I cannot swim at all
• I can swim but not with my face in the water
• Haven’t been swimming for a long time
• I have an injury and would like some help getting back to swimming

Have one of the following goals:
• Be less fearful of the water and learn the basics of swimming
• Learn to float, breath while swimming and learn arm movements while kicking
• Be able to swim with others
• Be able to swim 25 yards in the pool
• Get back in the pool after injury

If any to these interests you, we are looking to start an Adult Learn to Swim program and would like your input.

Hello, my name is John Ciraula and I am a Certified Adult Learn to Swim Instructor. About 2 years ago I began swimming with a young man that had a spinal cord injury. This summer I became a Certified Instructor for Adult Learn to Swim with Adaptive Methods from US Masters Swimming. I am also a Certified Lifeguard from the Red Cross.

I would like to offer any adult (age 21 and older) members of TRAS that either cannot swim or would like to begin swimming again post injury instruction and support in getting into the water.

If any of this interests you let us know!!!

Swimming Instruction will be provided on a volunteer – free of charge basis but there will be a cost related to the swimming facility we would need to work out.

The following are a few questions we would like you to answer and they will give us a starting point to build a program. Look forward to hearing from you and I promise I will do my best to bring Adult Learn to Swim - Adaptive Swimming to you!


John Ciraula - jctricoach@gmail.com
Your Name (Required) *
Your answer
Your age (Required) *
Your answer
Your email (Optional)
Your answer
List your previous swimming experience (Required) *
Tell us about your experience in the pool.
Your answer
List your reasons for wanting to learn to swim (Optional)
What would you like to get out of this program?
Your answer
Are you comfortable in the shallow end of a pool? (Required) *
Are you comfortable putting your face in the water? (Required) *
What location would you prefer? (Required) *
Duration you would like (Choose One - Required) *
Required
Day and Time (Select any that would work - Required)
5 PM
6 PM
7 PM
8 PM
Mon
Tues
Wed
Thurs
Fri
Sat
Do you want to share anything more or have a question? (Optional)
Your answer
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