Swimmer Questionnaire Swimmer Questionnaire Fill out the form below to let us learn a bit about you and your child. Order Number Student First Name: * Student Last Name: Student DOB: * Parent/Guardian: * Phone: * Email: * Address: * Does your swimmer have a medical need that requires a private lesson over a group lesson? * Yes No If yes, please give more information about the medical need. If your swimmer can be in a group class, what information would you like the teacher to know? What are your goals for the swimming lessons? * Is your child able to get into and out of the pool on their own or if not, will there be someone to assist them? * If you require a medical private lesson, please list all days and times you are available. (SwimWest can not guarantee a private lesson will be available during these times.) * With all new Medical Private students we do a trial lesson to make sure the private lesson is necessary over a group class and to determine that we will be able to provide an effective swim lesson for that swimmer. Are you willing to come in for a trial private lesson? * Yes No SwimWest is not able to bill or invoice third parties for tuition. Families must pay tuition directly to SwimWest.