Special Needs Questionnaire

							
																			Special Needs Questionnaire
												
							Child's Name*						

							Approximate Height*						

							Chronological Age*						

							Weight*						

							Developmental Age*						

							Gender*						

Male

Female

							Adult's First Name*						

							Adult's Last Name*						

							Email*						

							Best Contact Number*						

							How did you hear about Kay's All Swim School?*						
Our mission with special needs students is to allow them to have fun while exploring the water. The following questions will help us lead your child to a positive swimming experience!

							What is the child’s diagnosed special need?*						

							What is your child’s experience in the water?*						

							Does your child communicate verbally? What is the best communication method?*						

							Is your child on a behavior plan that we could support (cue words, hand signals, picture schedule, etc)?*						

							Are there any physical limitations the instructor should be aware of?*						

							Are there any body movements we should encourage or discourage?*						

							Has your child used ‘floaties’ or a floating device before?*						

							Are there any specific reinforcements that help your child succeed at home or school?*						

							What goals do you have for your child in this program?*						

							Other important information we should know about? (i.e. fears, negative experiences, potty trained?, what makes your child happy, etc)?*						

							Does your child have defiant behaviors? Does your child have physical or verbal aggression?  (If yes, please explain)*						

You will know this form has been successfully submitted
 
when you see the Thank You page.

What our swimmers have to say:

"Thank you for the great summer. Nara learned so much and had fun doing it. You are a wonderful teacher." Norm & Mabel
"I want you to know, though, and perhaps, again, what a special experience it was for Joy and the babes and me to spend in your swimming lessons. Your calm, positive reinforcement (over and over), your in-depth knowledge - not only of swimming techniques but of learning procedure -your happy approach: all these add up to superb teaching. We loved it! Thanks for everything!" With Love, linndith
"I've been a lifeguard and swim instructor. This is the most AMAZING program I've ever seen!"

Read more testimonials.

See the

KAY'S ALL SWIM SCHOOL – since 1974 –

We are full for 2022.
Please check back mid April for 2023 registration.

See you for our 50th year of Excellent Swim Instruction!

Our mission with special needs students is to allow them to have fun while exploring the water. The following questions will help us lead your child to a positive swimming experience!

What our swimmers have to say:

TOP 10 REASONS PARENTS GO TO KASS

Get Email Updates
Email

KAY'S ALL SWIM SCHOOL – since 1974 –

We are full for 2022. Please check back mid April for 2023 registration. See you for our 50th year of Excellent Swim Instruction!

Special Needs Questionnaire

Our mission with special needs students is to allow them to have fun while exploring the water. The following questions will help us lead your child to a positive swimming experience!

What our swimmers have to say:

TOP 10 REASONS PARENTS GO TO KASS

Get Email Updates

We are full for 2022.
Please check back mid April for 2023 registration.

See you for our 50th year of Excellent Swim Instruction!