Contact Information:
Caregiver/Parent First Name
Caregiver/Parent First Name
Email
Phone
Are you a YMCA Member?
Yes
No
Swimmer Information:
Swimmer Last Name
Swimmer Last Name
Age
Has your Swimmer participated in swim lessons before
Yes
No
Comfort & Experience:
How would you describe your child’s comfort level in the water?
(Multiple choice)
Very comfortable
Somewhat comfortable
Nervous
Fearful
Which best describes your child right now?
(Select all that apply)
Enjoys being in the water
Still getting used to water
Can float or kick
Can swim with assistance
Can swim independently
Support Needs:
Does your child have any support needs or diagnosis you'd like to share?
Are there any sensory sensitivities we should be aware of?
Noise
Touch
Water Temperature
Goggles/Face mask gear
Other
Please specify:
Location:
Which YMCA location do you prefer?
Please select...
Downtown Orlando
Dr. P. Phillips
Frank Deluca
J. Douglas Williams
Lake Nona
Leonard and Marjorie Williams
Osceola County
Oviedo
Winter Park
Titusville
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