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Swim Enrollment Form - Phoenix Valley
After you fill out this order enrollment form, we will contact you to go over details and availability before your lessons are booked and payment is taken. If you would like faster service and direct information please contact us at (480) 994-5437 or
sofun@kidtastics.com
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Email
*
Your email
Are you a new or existing customer?
*
I am a new customer
I am an existing customer
Coupon code?
Your answer
How did you hear about Kidtastics?
Your answer
Child's First & Last Name
*
Your answer
Child's Sex
*
Choose
Male
Female
Child's Age
*
Choose
6 months - 1 year
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Adult
What is your child’s experience in the water?
*
Your answer
Allergies?
Your answer
Other medical concerns?
Your answer
Child's Special Interest/ Favorite Things (ex. toys, sports, shows, books, games, music) This allows use to get to know your child better to form trust.
*
Your answer
Child's Fears/ Dislikes
*
Your answer
Do you have any behavioral strategies or positive reinforcers that you would like to share?
*
Your answer
What goals do you have for your child’s swim lesson?
*
Your answer
Communication information for Children with autism (click all that apply)
Can follow simple verbal instructions
Can follow written instructions
Uses visual schedule
Aggressive Behavior
Verbal
Limited verbal
Non-verbal
Uses sign language
Any things else we should know about your child?
Your answer
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