• Autism & Additional Needs Swim Program Enrolment Form

  • Parent/Carer's Details


  • Your preferred method of contact*

  • 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.*

  • Lesson Details

    Please record your 1st, 2nd and 3rd preference.
  • Preferred lesson time (you must give at least 2 options)

  • Preferred lesson time (you must give at least 2 options)*

  • Preferred lesson time (you must give at least 2 options)*

  • Who will bringing your child to their lessons at CrocStars?

  • Participants Details

  • D.O.B*
     / /
  • Gender*

  • Is the participant part of the NDIS (National Disability Insurance Scheme) ?*

  • How is the participants NDIS plan managed?

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  • What type of lesson would you like to book your child into?*
  • Medical Diagnosis (please select relevant boxes)*

  • Other Medical Conditions*

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  • ADHD Information
  • Cerebral Palsy Information (please tick the relevant boxes.)
  • Gross Motor Function Classification System (GMFCS)
  • Communication Function Classification System (CFCS)
  • Communication (Expressive)*

  • Does your child use any of these communication methods or tools?*

  • Communication (Receptive)*

  • We are legally required to undertake a risk assessment to ensure the safety and welfare of our students and staff. Please provide information that will assist us to have the appropriate controls in place.

  • Does your child have any of the following physical conditions that cause limited/restricted movement or that we need to be careful of in the water?*

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  • Is it common for your child to have any of the following behavioural issues?*

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  • Sensory Information*
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  • If your child has a physical disability, do they need assistance to enter the pool?

  • 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)*
  • Please rate your child's swimming ability.*

  • Education, Activities and Therapies

    This information gives us a better understanding of the level of supports needed.

  • To help us develop a suitable program for your child's individual needs, it's very helpful if we have access to your child's specialist reports. Please attach below;

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  • Other Information

  • Where did you hear about us?*

  • Do you consent to photographs of your child being taken for CrocStars and Autism Swim social media/website/internet content?*
  • Do you consent to your child's swimming data being used as part of a research study?*

  • We would love your support, please Like and/or Share our Facebook Page

  • Thank you for completing our online enrolment form. Please click onto the submit button to send to our head office for review.

  • Office Use Only

    To be completed by CrocStars Management

  • Record participants goals and identify the risks and controls for the activities.

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  • Risk Priority

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