Parent Name *

First Name

Last Name

Phone

(###)

###

####

Swimmer's Name

First Name

Last Name

Swimmer's Birthdate

MM

DD

YYYY

Is your child available during the week (Monday-Friday) between the times of 5pm and 8:15pm?

Yes (child is available each of those days during that time frame)

Child is available most days during that time frame

Child is available only some days during that time frame

Child does not have availability throughout that entire time frame

Is your child able to commit to 4 or more training days per week *

Yes

No

How soon would your child be ready to start if he/she passes the assessments?

Right Away

1-2 weeks

2-3 weeks

Longer

Would the swimmer have difficulty arriving to practice on time consistently?

No

Yes

Possibly

Child’s current swimming skills *

Click all that apply

No swimming skills at all

Can put face in the water

Can float in the water without assistance

Can doggy paddle or tread water

Can swim in deep water

Can swim a full length of a standard 25yd pool without breaks

Can swim 2 or more competitive strokes

How does your child respond to challenges *

Does not like being challenged. Prone to quit.

Willing to work hard and accept challenges when externally motivated.

Enjoys being challenged and working hard. Needs no external motivation.