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Aquatic Service Enrolment Information
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Aquatic Service Enrolment Information
Type of aquatic service being delivered
Funding being used (if applicable)
Start date of lessons/sessions
Number of sessions (weekly)
Swimmer's name
Date of birth
Diagnosis
What does your swimmer absolutely love?
What can we use as reinforcement options?
What are your swimmer's strengths?
What would your swimmer do if they saw a body of water?
What would your swimmer do if they fell into a body of water?
What is your swimmer's experience with lessons/aquatic services?
Long term aquatics goals
Short term aquatic goals
Goals as outlined by funding body (if applicable)
Therapist's name (if applicable
Contact
Address
Phone number
Comments
Please let us know of strategies that have worked to support the above
Expressive communication
Verbal
Verbal (limited)
Non-Verbal
Sign Language
PECS
App on iPad or device
Other
Other (please specify):
Receptive communication
Follows simple direction
Follows multi-step direction
Relies heavily on visual information
Other
Sensory needs
Please outline your swimmer's sensory needs and any adaptations and considerations we need to consider.
Seizures
Does your swimmer have any reported seizure activity? If so, please provide a seizure management plan from your general practitioner.
Other information
Is there anything else that would be useful for us to know in terms of providing an aquatic service to your swimmer?
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