Autism & Additional Needs Swim Program Enrolment Form

LESSON TIMES AT OUR LOCATIONS ON THE CENTRAL COAST


LOCATION	WEEKDAY AM	WEEKDAY PM	WEEKEND AM/PM
Wyong	Monday 10.15am-2.15pm Wednesday 8.00am-1.00pm Thursday 10.00am-2.00pm	Monday 3.30pm-7.00pm Wednesday 3.30pm-7.00pm	N/A
Woy Woy (Public Hospital)	Thursday 9.00am-1.00pm Friday 9.00am-1.00pm	Wed 4.15pm-7.00pm Thursday 1.30pm-7.00pm Friday 1.30pm-6.00pm	Saturday 11.30am-5.00pm
Berkeley Vale	N/A	Monday - Friday 4.00pm-7.00pm	Saturday & Sunday 8.00am-6.00pm
Woy Woy (Brisbane Water)	N/A	Tuesday 4.00pm-7.00pm	Saturday 1.30pm-5.00pm Sunday 8.00am-11.00am

Which CrocStars Swim Centre would you like to book into? Please view the available times above.*

Wyong Public HospitalWoy Woy Public HospitalBerkeley Vale Private HospitalBrisbane Water Private Hospital

What are some of your child's interests?*
What motivates your child that we could potentially use as reinforcers?*
What calms your child if he/she is upset?*
What would your child do if they saw a body of water? Eg; jump in, be very cautious, would never go in without an adult*
What would your child do if they fell into a body of water?*
If your child has a physical disability, do they need assistance to enter the pool?

My child can independently enter the pool by walking down the ramp access and holding onto the railing.My child will need assistance from the swim teacher to enter via the ramp access.My child will need to enter the pool via the hoist or chair lift .Other
Is your child toilet trained? (If no, your child must wear a two layer protection in the water. You will receive more information from CrocStars about this in your Welcome Pack)*

YesNo

Office Use Only

To be completed by CrocStars Management
Record participants goals and identify the risks and controls for the activities.
Risk Priority
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3.
Should be Empty:

Parent/Carer's Details