School Swimming - Water Skills for Life Programme Consent Form

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School Swimming - Water Skills for Life Programme Consent Form

Child Name: *

School: *

Room: *

Year Level: *

Parent Name: *

Emergency Contact Number: *

I am able to help with swimming sessions poolside *

CHILD SWIM ABILITY - CHOOSE ONE ONLY *

My child cannot put their head underwater
My child is happy to put their head underwater
My child is able to float unassisted on their back
My child can swim 5m unassisted in the water to the edge of the pool
My child can swim unassisted up to 15m in the pool (any stroke)
My child can swim up to 25m in the pool (any stroke)
My child can swim up to 50m in the pool (any stroke)
My child can swim up to or over 100m in the pool (any stroke)

I will ensure that my child is equipped with named swim togs and a named towel on each swimming day. I will provide a note if my child has any medical conditions or illnesses which prevents their participation in the lessons.

Does your child have any health or learning issues that the swim school needs to be aware of? *

If Yes, Please explain the Health or Learning issue we need to be aware of