Adapted Swimming Lessons Enrolment Form

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ADAPTEDSWIMMINGLESSONS

ENROLMENTFORM

To enrol in Adapted Swimming Lessons, please complete the form below with as much detail as possible. This information is essential for our staff to provide engaging, informative, and safe lessons tailored to each student's needs. Your input ensures that we can create a supportive and effective learning environment for all participants.

Parent's/Guardian's Details

Parent or Guardian's Full Name(Required)

Relationship to Student(Required)

Email(Required)

Contact Number(Required)

Student's Details

Full Name(Required)

Address(Required)

Suburb(Required)

Postcode(Required)

Child's Date of Birth(Required)

DD slash MM slash YYYY

Student's NDIS#(Required)

Which venue would you like to enrol at?(Required)

NDIS Plan Details

NDIS Plan Management(Required)

Agency Managed

Self Managed

Plan Managed

Plan Manager's details if applicable:

Student's Health Details

If the student has any severe allergies or illnesses that require an action plan, please provide us with a copy of your child’s current action plan.

Asthma(Required)

Yes

Autism(Required)

Yes

Aspergers(Required)

Yes

Allergies(Required)

Yes

Epilepsy(Required)

Yes

Seizures(Required)

Yes

Diabetes(Required)

Yes

Hearing Problems(Required)

Yes

ADHD(Required)

Yes

Please provide full details if you answered yes to any of the above or there are any additional health details you need to share?

Does the student have aggressive tendencies?(Required)

Yes

Please provide details:(Required)

Additional Information

Has the student been exposed to aquatic environments?

Has the student had swimming lessons in the past?

Does the student display positive behaviour towards swimming?

Is there any fear from you or the student in and around aquatic environments?

What are the student's hobbies or interests?

What disciplinary consequences are usually effective for innapropriate behaviour at home?

Is the student comfortable in a noisy environment?

Is there anything specific you would like addressed by us within the student's lessons?

Have you ever had to rescue the student in an aquatic environment? If so, what environment and what age?

Are there any triggers that may cause anxiety in the student?

Is there anything else that you can think of that will help us with the student in the water?

FACILITIES

Logan North

Aquatic Centre

Beenleigh

Aquatic Centre

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