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Holy Family Primary School - Swimmer Ability Form
Please complete the following swimmer ability form as accurately as possible.
Swimmer Name
*
First
Last
Has Your Swimmer Had Lessons Before?
*
Yes
No
IF yes -Please select the most recent badge/stage they attained. If you can't remember or are unsure - please select 'Not Sure'
*
Not Sure
No badges received
Duckling 1
Duckling 2
Duckling 3
Duckling 4
Duckling 5
Stanley 1
Stanley 2
Stanley 3
Stanley 4
Stanley 5
Stanley 6
Stanley 7
Puffin Award
I CAN SWIM award
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage 6
Stage 7
Stage 8
Stage 9
Water Skills 1
Water Skills 2
Water Skills 3
Water Skills 4
Water Skills 5
Water Skills 6
Octopus 1
Octopus 2
Octopus 3
Goldfish 1
Goldfish 2
Goldfish 3
Angelfish 1
Angelfish 2
Angelfish 3
Kingfisher 1
Kingfisher 2
Kingfisher 3
Shark 1
Shark 2
Shark 3
Dolphin 1
Dolphin 2
Bronze Award
Silver Award
Gold Award
Bronze Swimmer
Silver Swimmer
Gold Swimmer
5m
10m
15m
20m
25m
50m
100m
200m
400m
600m
800m
1000m
1mile
Has your swimmer ever had a negative experience of water/lessons or has any anxiety toward swimming lessons/water?
*
Yes
No
IF your swimmer has any anxiety or experienced negative situations in water/lessons please describe as accurately as possible your swimmer's experience and potential concerns you or they may have? Please leave blank if not applicable.
Medical considerations: Does your swimmer require medication or special considerations towards a medical condition which may be effected by exercise?
*
I am happy for my swimmer to attend swimming lessons beginning in 2024.
*
Yes
No
Parent/Guardian Email Address
*
Today's Date
*
DD
/
MM
/
YYYY
