1:1 Swim Fall 2022
Please complete the form below. An email will be sent to confirm slots by Monday 1/9. 
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Child's Name *
Child's Age *
Please provide your child's primary diagnosis *
Please list any allergies your child has
Has your child participated in this program before? *
Does your child have experience swimming? *
Describe any challenges your child may have when it comes to swimming. (going underwater, blowing bubbles, going on their back, transitioning out of the water, etc.) *
Please pick your first time slot/day option *
Please pick your second time slot/day option *
Please include any information you think would be helpful to our instructors (what motivates your swimmer, what are some things they like, do they have any fears, sensitivities, etc.) *
Your name (primary contact) *
Your email address for communication *
Your phone number for (text) communication *
Because of the great level of interest in our swim program, and the limited slots, we ask that families do not miss more than 2 sessions without proper notice. Of course life happens and we completely understand that, but repeated no shows will have their slot given to someone on the waitlist.
Thank you- we can't wait to get in the pool!
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