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 *
Your answer
Child's First Name *
Your answer
To help us identify swim goals for your child, please check any or all statements that are true for your child:
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.
Your answer
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?
Your answer
If you are a returning swimmer, is there a particular instructor you child has connected well with in the past?
Your answer
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