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2. 
4. Welcome to the Group Swim Lesson Level Assessment Form. This quick assessment is designed to help determine the appropriate swim level based on swimmers age and ability. It works best if you can accurately assets your swimmer’s skills. If you are unsure if your swimmer can complete a specific task, then you should answer no. It is better to error on the side of caution as students will do better in a class that is easy for them verse one that is too hard for them. This form does not consider a student’s unique developmental ability and does not guarantee perfect placement. If level placement is determined to not be correct once students start class, then teachers will work with swimmers to accommodate as able.
6. Please select your swimmers age: *

   1. 6 - 17 months old
   2. 18 - 23 months old
   3. 2 years old
   4. 3 years old
   5. 4 years old
   6. 5 years old
   7. 6+ years old
8. Is your swimmer comfortable in the water? *

   1. Yes
   2. No
9. Does your swimmer know how to and are they comfortable blowing bubbles? *

   1. Yes
   2. No
10. Can your swimmer climb in and out of the water without support? *

    1. Yes
    2. No
12. Has your swimmer participated in any group activity independently? *

    (i.e. preschool, kid's day out, art class, sports activities, gymnastics etc.)

    1. Yes
    2. No
13. Is your swimmer comfortable in water? *

    (When visiting aquatic facilities, do they enjoy the water and have fun in the water. Do they get their face wet?)

    1. Yes
    2. No
15. Is your swimmer comfortable putting their face in the water?

    1. Yes
    2. No
16. Is your swimmer able to take instruction from a teacher and pay attention during the class?

    1. Yes
    2. No
17. When in the water, does you swimmer attempt to swim unassisted?

    Without flotation devices or being held. Does not need to be able to swim, just attempt.

    1. Yes
    2. No
19. Is your swimmer comfortable putting their face in the water? *

    1. Yes
    2. No
20. Is your swimmer able to take instruction from a teacher and pay attention during the class? *

    1. Yes
    2. No
21. When in the water, does you swimmer attempt to swim unassisted? *

    Without flotation devices or being held. Does not need to be able to swim, just attempt.

    1. Yes
    2. No
23. Is your swimmer in Kindergarten? *

    1. Yes
    2. No
24. Is your swimmer able to take instruction from a teacher and pay attention during the class? *

    1. Yes
    2. No
26. Is your swimmer comfortable putting their face in the water?

    1. Yes
    2. No
27. Is your swimmer able to take instruction from a teacher and pay attention during the class?

    1. Yes
    2. No
28. When in the water, does you swimmer attempt to swim unassisted?

    Without flotation devices or being held. Does not need to be able to swim, just attempt.

    1. Yes
    2. No
30. Does your swimmer willingly put their face in the water? *

    1. Yes
    2. No
31. Can your swimmer blow mouth and nose bubbles? *

    1. Yes
    2. No
32. Can your swimmer swim freestyle continuously for at least 5 yards with their face in the water unassisted? *

    1. Yes
    2. No
34. Can your swimmer float on their back continuously for at least 10 seconds unassisted? *

    1. Yes
    2. No
35. Can your swimmer do backstroke continuously for at least 5 yards unassisted? *

    1. Yes
    2. No
36. Can your swimmer swim freestyle continuously for at least 10 yards with rhythmic breathing? *

    1. Yes
    2. No
38. Can your swimmer float on their back for 30 seconds unassisted?

    1. Yes
    2. No
39. Can your swimmer swim backstroke continuously for at least 10 yards unassisted?

    1. Yes
    2. No
40. Can your swimmer tread water continuously in deep water for 30 seconds?

    1. Yes
    2. No
42. Can your swimmer swim freestyle continuously for at least 15 yards with rhytmic breathing?

    1. Yes
    2. No
43. Can your swimmer float on their back for 60 seconds unassisted?

    1. Yes
    2. No
44. Can your swimmer swim backstroke continuously for at least 15 yards unassisted?

    1. Yes
    2. No
46. Can your swimmer tread water continuously in deep water for 60 seconds?

    1. Yes
    2. No
47. Can your swimmer enter the water head first from a kneeling position?

    1. Yes
    2. No
48. Does your swimmer know how to perform the breaststroke kick?

    1. Yes
    2. No
50. Does your swimmer know how to perform the dolphin kick?

    1. Yes
    2. No
52. Does you swimmer willingly put their face in the water? *

    1. Yes
    2. No
53. Can your swimmer blow mouth and nose bubbles?*

    1. Yes
    2. No
54. Can your swimmer swim freestyle continuously for at least 5 yards with their face in the water unassisted?

    1. Yes
    2. No
56. Can your swimmer float on their back continuously for at least 10 seconds unassisted?*

    1. Yes
    2. No
57. Can your swimmer do backstroke continuously for at least 5 yards unassisted?*

    1. Yes
    2. No
58. Can your swimmer swim freestyle continusouly for at least 10 yards with rhythmic breathing?*

    1. Yes
    2. No
60. Can your swimmer float on their back for 30 seconds unassisted?*

    1. Yes
    2. No
61. Can your swimmer swim backstroke continuously for at least 10 yards unassisted?*

    1. Yes
    2. No
62. Can your swimmer tread water continuously in deep water for 30 seconds?*

    1. Yes
    2. No
64. Can your swimmer swim freestyle continuously for at least 15 yards with rhythmic breathing.*

    1. Yes
    2. No
65. Can your swimmer float on their back for 60 seconds unassisted?*

    1. Yes
    2. No
66. Can your swimmer swim backstroke continuously for at least 15 yards unassisted?*

    1. Yes
    2. No
68. Can your swimmer tread water continuousy in deep water for 60 seconds?*

    1. Yes
    2. No
69. Can your swimmer enter the water head first from a kneeling position?*

    1. Yes
    2. No
70. Does your swimmer know how to perform the breaststroke kick?*

    1. Yes
    2. No
72. Does your swimmer know how to perform the dolphin kick?*

    1. Yes
    2. No
74. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
76. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
78. Based on the answers provided, your swimmer's appropriate level has been determined.

    Please choose option below and then click submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
80. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click the submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
82. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click the submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
84. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click the submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
86. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click the submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
88. Based on the answers provided, your swimmer's appropriate level has been determined.*

    Please choose option below and then click the submit button.

    1. All answers above are correct and I am ready to see the appropriate swim level for my swimmer.
    2. Reset the form.
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