Online Child Assessment Form

Please make sure to have access to this site while filling out the form as you will have to refer back to watch the walkthrough video and to choose days/times for lessons.

Child Assessment
Parent or Guardian Name
Parent or Guardian Name
First
Last
Best way to contact you:
Swimmer Name
Swimmer Name
First
Last
GENERAL
Potty-trained? (no accidents in the past 6 months)
Previous swim experience?
Is your child okay with putting head in water?
Family has or vacations near:
BEHAVIOR
Aggressive behavior?
COMMUNICATION
Expressive (talking):
Receptive (understands) – Follows simple directions
Receptive (understands) – Uses visual schedule
SPECIAL INTERESTS
SENSORY
GOALS