BlueFit Swimming - Swim Assessment

Date today

DayMonthYear
Date
Department
Campaign
Location
Lead Source
Sales Stage
Admin Notes
Attention: Please check if customer has a contract in links first before contacting. Admin
SALT Location
Your Location*
Name*

First NameLast Name
Email*
example@example.com.au
Mobile Number*
Please enter a valid phone number.
Student Details
Student First Name*
Gender*
Student Date of Birth

DayMonthYear
Date
What is the current / last level they were enrolled in with SwimFit?
Is {child_name} at school?

YesNo
Child Age
Child Age Calculation
As of next year, has {child_name} started Primary School?*

YesNo
Has {child_name} had any swimming lessons previously?*

YesNo
Has {child_name} had any swimming lessons previously?*

YesNo
Has {child_name} had any swimming lessons previously?*

YesNo
Can {child_name} swim independently - no flotation aids?*

YesNo
Can {child_name} swim 50m of all 4 strokes; freestyle, backstroke, breaststroke, butterfly and perform a tumble turn?*

YesNo
Can {child_name} swim breaststroke?*

YesNo
Can {child_name} swim 12m of freestyle and backstroke, perform a basic breaststroke and butterfly kick?*

YesNo
Can {child_name} perform a basic breaststroke kick?*

YesNo
Can {child_name} swim 12m freestyle with a basic breathing pattern?*

YesNo
Can {child_name} swim independently and are they able to perform basic freestyle?*

YesNo
Is {child_name} confident and able to swim independently?*

YesNo
Can {child_name} swim freestyle with a basic breathing pattern and backstroke?*

YesNo
Can {child_name} confidently swim freestyle and backstroke, basic breaststroke and butterfly kick?*

YesNo
Is {child_name} confident and able to swim independently?*

YesNo
Can {child_name} swim freestyle with a basic breathing pattern and basic backstroke?

YesNo
Comment
AC Location
Your Level - Aquatots
Your Level - Squid
Your Level - Waterplay
Your Level - Starfish
Your Level - Clownfish
Your Level - Seahorse
Your Level - Stingray
Your Level - Angelfish
Your Level - Jellyfish
Your Level - Platypus
Your Level - Dolphin
Your Level - Squads
Your Level - Adolescent Beginner
Your Level - Adolescent Intermediate
Your Level - Adolescent Advanced
Your Level - Adult Beginner
Your Level - Adult Intermediate
iClass Locatons
iClass Location code
utm_source
utm_medium
utm_campaign
utm_content
utm_term
device
placement
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Should be Empty:

Student Details

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