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Swim For All Special Needs Information Form
The following questions will help me guide and individualize your child's lessons. As a certified Swim Whisperer I want to know as much about your child and their water comfort level prior to the first lesson.
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Email
*
Your email
Child's name and age
*
Your answer
Parent's name, email address, and phone number
*
Your answer
What is your child's diagnosed special need or needs?
*
Your answer
Does your child communicate verbally?
*
Yes
No
Required
Is your child receiving therapy? SLP? OT? PT? If yes, what reinforcements does the therapist use?
*
Your answer
Are their body movements I should encourage or discourage?
*
Your answer
Is your child toilet trained? if not they must wear a snug fitting swim diaper
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Yes
No
What is your child's experience in the water?
*
Your answer
What goals do you have for your child in regards to swimming and water safety?
*
Your answer
Any other important information(i.e. fears, anxieties, things that make your child happy, etc)?
*
Your answer
Send me a copy of my responses.
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