Swimmer Information Form
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 in the water without a parent present
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?
Please let us know if your child has any needs we can accommodate, such as tubes in ears, asthma, seizure disorders, autism, attention/focus issues, sensory processing concerns, etc.
May we take photos of this child for use in promoting future Y programs?
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?
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