Adaptive Swim Lessons Intake

Thank you for your interest in Adaptive Swim Lessons! Please complete the intake form so that we can best anticipate the participant's needs and determine helpful accommodations. Acceptance is based on instructor availability, ability to provide necessary accommodations and essential eligibility criteria for all swimmers. Please note: you only need to fill out the sections that apply to your child.

Questions? Please contact Colleen Sheelen, Aquatics Director at [email protected]
Swimmer's Details
Swimmer's Name
Swimmer's Age
Medical Concerns
 
Need to add an additional swimmer? Click the "+".
Please describe how the swimmer's needs affect their participation in swim lessons so that we can personalize a program to meet their individual needs.

Let's dig a little deeper

Please list any current injuries and/or physical limitations our staff should be aware of:
Bowel and bladder control:(Required)
Follows a 1-step direction:(Required)
Participant communicates through:(Required)
Please feel free to select more than one option.
Describe any sensory experiences that may cause the swimmer discomfort like loud noise, bright lights, large groups, getting splashed, etc.
Social-Emotional:
Select any behaviors that have been observed within the past 6 months which may impact participation in swim lessons.
Is the participant fearful of the water?(Required)
Select all skills that the swimmer can complete.
Essential Eligibility Criteria(Required)

Individuals applying for any swim program at BSC must meet the following essential eligibility criteria:

1. Enter, remain in and exit the water safely without compromising their own safety or the safety of others
2. Be fully Bladder and bowel toilet trained or wear leak proof rubber diaper/swim pants specifically designed for immersion in water which are securely fitted around waist and thighs
3. Be able to follow simple instructions to maintain safety in the water and advance in skills
4. Free from the following:
Diarrhea or gastrointestinal (stomach) disease or virus in the past seven days
-Communicable skin disease, excessive sunburn, open blisters, cuts or bandages
-Sore or inflamed eyes, cold, nasal or ear discharge
-Difficulty breathing or compromised airway
Not under the influence of drugs and/or alcohol

Thank you for completing the Adaptive Swim Intake form! Staff from the aquatics department will reach out to review your intake and next steps.