Swim Lessons – Ashby Recreational Association

Name(Required)

First Last

Phone(Required)

Email(Required)

Child's Name(Required)

First Last

Child's Age(Required)

My child:(Required)

(Please check the best description of your child)

is completely new to the water

is in the water seasonally or on occasion

is in the water monthly

is in the water weekly

has participated in a swim team

My child is:(Required)

(Please check the best description of your child)

unsafely overconfident in the water

generally panicky/fearful in the water

generally uncomfortable in the water

generally comfortable in the water

confident in the water

My child can:

(Please check any that apply to your child)

blow bubbles in the water

submerge their face underwater

hold their breath underwater

submerge their whole body underwater

retrieve sinkies/toys from the pool floor ~2 feet deep

My child can:(Required)

(Please check the best description of your child)

push off of the wall

propel themselves forward in the water (either by kicking with their legs or pulling with their arms)

swim less than 5 feet of front crawl/freestyle

swim more than 5 feet of front crawl/freestyle

My child can:

(Please check any that apply to your child)

swim front crawl/freestyle with proper breathing technique

swim equal to or greater than 15 feet of front crawl/freestyle

swim another stroke (backstroke, breastroke, butterfly)

perform a competitive dive

Goals for Swim Lessons (Part 1)(Required)

(Please check ALL that apply)

I want my child to become safe in the water.

I want my child to get exposure to the water.

I want my child to overcome their fear of the water.

I want my child to become independent in the water.

None of the above

Goals for Swim Lessons (Part 2)(Required)

(Please check ALL that apply)

I want my child to gain swimming endurance.

I want my child to learn a specific skill, technique, or stroke.

I want my child to refine a specific skill, technique, or stroke.

I want my child to join Ashby Swim Team or their Junior Anacondas program in the future.

None of the above

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