EmailMe Form - 'Swim For Sheilah Assessment'

I am applying: *

For Myself - Caregiver/Nanny

As an Employer

Caregiver's Name *

First Last

Caregiver's Email *

Caregiver'sPhone *

### - ### - ####

Caregiver's Location *

Preferred contact *

Call

Email

Current Employer's Name

First Last

Employer's Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Access to a pool? *

Yes

No

Swimming Experience(please check all that apply) *

I do NOT need an assessment as I know I can't swim at all. I would like swim lessons to learn.

I can jump in 6 feet(deep end) of a pool and swim to the side

I can tread water with my head up for 2 minutes

I can swim 25 meters with face in the water

I can float on my back unaided for 1 minute