intake | swim

Adaptive Aquatics Intake Form

The following questions will help us plan how to best meet your swimmer’s individual needs, in order to set both teacher and student up for success. Please be as open as possible. We will not turn your child away nor discriminate based on what is listed. We love our adaptive swimmers!

Where do you want to swim?

Parent Name

Last name

Phone

Swimmer's Name

Swimmer's Birthday

Month

Day

Year

Describe disability/diagnosis or reason for requiring specialized instruction:

What is your child’s primary form of communication (verbal, sign, AAC, etc)?

How does your child interact with other same-age kids?

Does your child have any physical differences or support needs (vision, hearing, mobility, etc)?

Is your child potty-trained?

Have they had any past trauma or bad experience with water?

Does your child have any sensory sensitivities or triggers we should be aware of?

How does your child show they are happy/excited?

How do they express frustration or fear?

Has your child ever participated in any structured swimming lesson/activity?

What motivates or positively reinforces your child?

Is there anything else you could share that would help us support your child’s learning?

Swimmerman
Swim School

Connect with us:

We would love to hear from you! Fill in the form and we will get right back to you!