Swimmer Information Form

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Thank you for choosing swim lessons at the Superior Y for your child! Your student will be placed in a small group with other children of like skill and age. To help us know how to best match your child with an ideal group, please answer this short skill assessment.

Child's Last Name *

Child's First Name *

To help us identify swim goals for your child, please check any or all statements that are true for your child:

Able to follow verbal instructions

Comfortable with face and ears underwater

Able to swim short distances underwater in shallow water

Able to float on back for 15-30 seconds without a lifejacket

Able to jump into deep water and return safely to a wall without a lifejacket

Able to swim one length of the pool without flotation assistance

Able to swim one length of front crawl with some understanding of rotary breathing and one length of backstroke

Able to swim one length of breaststroke

Able to swim one length of butterfly

Does this child have any health, learning, or behavioral concerns that you would like the lifeguards and/or instructor to be made aware of?

To best support your child's learning, please tell us about any accommodations swimmer may require to access their ideal learning environment (eg, availability of water wheelchair, visual aids to facilitate instruction with a non-verbal swimmer, use of social stories or first/then boards to facilitate smoother transitions, lessons scheduled during a quieter sensory environment, etc):

May we take photos of this child for use in promoting future Y programs? *

Yes

Has this child been in swim lessons before? If you are new to our program, what brought you to our Y?

If you are a returning swimmer, is there a particular instructor you child has connected well with in the past?

Submit

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