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 *

Please select each that applies to your child: *

My child is not comfortable with his/her face in the water
My child is comfortable with his/her head under the water
My child is able to float unassisted on back
My child is able to swim 5m unassisted in the water to pool edge
My child is able to swim (any stroke) 15 metres in the water
My child can swim (any stroke) 25 metres (1 length) in the water
My child is confident in deep water
My child attends swimming lessons outside of school

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

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.

Any additional information: