Adaptive Aquatics Request Form
Please fill in the participant information form below. Fields marked with a red star are mandatory.
Have questions along the way? See the Frequently Asked Questions section.
Participant's Name
Participant/Parent/Guardian Phone
Participant Date of Birth
Parent/Guardian Name
Participant/Parent/Guardian Email
STEP 1: What goals need worked toward in a session?
Please be as descriptive as possible so the instructor can prepare accordingly
STEP 2: Please describe the diagnosis that affects the way the participant behaves, learns, communicates, or moves.
By providing specific challenges, the instructor can be prepared to work with the participant as best as possible
STEP 3: Professional recommendation.
In order to participate in the Adaptive Aquatics program, we require a written recommendation by a qualified professional. This can be obtained from a therapist, teacher or physician. This should outline the need for an adapted setting and should include learning techniques that have worked well for this student. Any restrictions or precautions the instructor should be aware of should be incorporated into this letter. This request will be forwarded on to your desired instructor once the letter has been received.
By checking this box you agree to provide a recommendation letter to the Aquatics Coordinator within 7 days of this submission.
STEP 4: Choose your instructor based on their availability on previous page.
For instructor profiles, please visit www.NorwalkRec.com/private-swim-lessons.
Waitlist for Monica K
STEP 5: Review the policies.
Dismissal Policy: If a participant fails to show up twice for lessons without adequate notice, it will be assumed that the lessons are no longer needed and any lessons scheduled will be cancelled without refund If a participant fails to complete all of their lessons within a 3 month period (unless the issue is due to a medical or family emergency), no refund or credit will be issued If a participant is late to a lesson, they will be charged the full amount, even if the lesson has to be shortened due to the tardiness. Some instructors set up lessons back to back or even leading up to public group lessons, please be considerate of their time
By checking this box you agree to the full policies for Private Swim Lessons as they appear in the document on the previous page.
SUBMIT THE LESSON REQUEST FORM