special needs students

Students with Special Needs

Welcome Families. Please fill out this intake form and provide as much detail about your Childs needs and diagnosis.

If you have any questions for me, please contact me directly via email or text and I will get back to you that same day.

Thank you

-Florencio

*Those families on Self Direct programs: Please note: we do not accept direct payments from self direct. Parents pay in full upon registration and then we provide you with a detailed receipt for parents to submit for reimbursement on their own.

PARENT'S FIRST AND LAST NAME

PARENTS CELL PHONE NUMBER (number we can send text)

PARENT EMAIL

CHILD'S FIRST AND LAST NAMES

CHILD'S DATE OF BIRTH

PLEASE DESCRIBE YOUR CHILD'S SPECIAL NEEDS IN FULL DETAIL (diagnois, verbal/non-verbal/

WHAT IS YOUR CHILD'S EXPERIENCE WITH SWIM LESSONS AND COMFORT WITH WATER

PLEASE PROVIDE US WITH ANY PERTINENT INFORMATION THAT WILL HELP US

HOW DID YOU HEAR ABOUT US?

Thanks for submitting, I will get back to you within 24 hours via phone, text, and/ or email