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:

"About 20 years ago you taught my two boys to swim. Well, I have a new little one. He's 3 years old now. I've been taking him to lessons elsewhere and I'm having the same problem I had with the older boys that ultimately led me to you those many years ago. The water is too cold and my son can't focus when he's freezing! I look forward to getting back to you and your warm water!" Thank you, Denise
Kay's always has the cleanest and warmest water. My mother brought me to Kay's as a child, and now I bring my children to Kay's every summer!
"We both want to express our appreciation for 'a job well done'. The children have all progressed at an amazing pace since we began swimming lessons last summer. Their fear of water has diminished drastically and their form and strokes have improved dramatically. Our thanks for your patience, words of encouragement and willingness to work with them and us in swimming lessons. We felt this was something they could use throughout their life and appreciate the extra effort you put forth in teaching them!" Richard & Brenda

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KAY'S ALL SWIM SCHOOL – since 1974 –

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

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KAY'S ALL SWIM SCHOOL – since 1974 –

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