Adaptive Aquatics Intake Form

Small group and private lesson settings available for special needs students.

Fill out the Adaptive Aquatics Intake Form below. The Crawfish Swim School's Adaptive Aquatics Director, Sarah Mobley, will contact you within 1-2 business days to discuss your goals for your child and schedule an in person assessment. After their assessment your child will be placed into the appropriate class and we will assist you in completing your registration.

We look forward to meeting and serving you and your family! Please feel free to reach out to us through the contact page if you have any additional questions.

Last Name

First Name

Address

Phone

Child's Name

Birthdate

MM/DD/YY

Child's Age

Tshirt Size

How did you hear about us?

In which session do you want to enroll?

Preferred Location

Preferred method of contact from our staff.

Describe your child's personality.

What is your child's specific diagnosis?

Does your child require assistance with any of the following? Check all that apply. WalkingParticipating in/remaining with a groupWaiting their turnGrasping/manipulating objectsToiletingListening/following directionsNone

How does your child communicate? VerbalNonverbal

If your child is nonverbal, what forms of communication are used?

Describe any special medical needs or allergies that we should know about.

Please list any current providers or services that your child receives.

Does the student have any medical or physical restrictions or is the student on any medical action plans?

Describe any special accommodations necessary for physical disabilities.

Describe any specific behavior(s) you child has that we should be aware of prior to evaluation.

Has your child participated in any other recreational activities? If yes, please list.

Please feel free to share any additional information about your child here.

Please ask any questions you may have for us here.

Please allow 1-2 business days for contact once your form has been submitted.

* Required Field

Adaptive Aquatics Intake Form

Adaptive Aquatics Intake Form

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