Swimming With Autism - Registration Form - Fall 2022

 

PARENT / GUARDIAN INFORMATION

IMPORTANT NOTE:
Please ADD info@autismakron.org to your email contact address book to ensure emails do not go to your junk folder.

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SWIMMER - GENERAL INFORMATION
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SWIMMER - MEDICAL INFORMATION
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In the box below, please provide any detailed information regarding the above diagnosis that will help us work with your swimmer safely and effectively. Explain any health/medical conditions or concerns and any related special instructions.
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CHOOSE LESSON TIME

This program involves 9 weeks of individual lessons lasting 30 minutes and scheduled on Monday and Wednesday each week at the YMCA located at 477 E Market Street, Akron OH 44304. This program has set dates and times for execution with make up lessons only scheduled should the YMCA have to cancel a lesson due to pool shut down or inclement weather. If a swimmer is not able to attend a lesson due to illness, instructors will adjust instruction accordingly to keep swimmers on task.

Please make a first and second choice. We will do our best to honor your first choice, but this might not always be possible due to availability. Swimmer will attend lessons at these days and times each week.

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SWIMMER - WATER EXPERIENCE

Explain your swimmer's capabilities in the areas that follow so we can begin to get to know them.

My swimmer can ....

Climb in and out of the pool
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Put their face in the water
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Submerge their head under water
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Float on their stomach
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Float on their back
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Push off the wall
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Move their arms in the water
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Kick their legs
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Move their arms and legs together in the water
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Blow bubbles in the water
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Hold breath under water
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Swim more than 15 feet in the pool
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