Splashland LLC – Swim Lesson(s) Registration Form – Summer 2023
Name of Participant(s)____________________age_____ ______________________ age____
____________________age____ __________________age____ ________________ __age____
Parent/Guardian____________________________________________________________________
Address: ____________________________________City________________Zip_________________
Best Phone # to be reached (circle): Cell_____________________Home_______________________
Work________________________ Email________________________________________________
5 Students per class appx. Classes will be ½ hr. lesson ~ Monday – Thursday ~ for 2 weeks
(Circle date): Session: I. June 5-15th II. June 19-29th III. July 10-20th IV. July 24th
--August 3rd
(Circle time) : Time. 9am 9:45 10:30 am 3 yrs & under {Parent-Tot} 9 am session only
What water skills does your child possess? Circle Level (If more than one child, note child’s name next
to skill level). If they possess all skills for that level they should be on next level. If they are still working
to master those skills put them on that level. We can adjust as needed first day of classes.
Parent-Tot: 9 months to 3 yrs. with parent, Introduction to water skills/ water games, swim diaper required.
~~~~ 4 Years and Over ~ without parent in group setting~~~ See below levels
Level 1: Fully submerge face 3 sec., bob 10 times with support, front & back float w/ support, blow
bubbles, enter and exit pool independently, walk 5 yds in chest deep water, supported kick - front & back.
Level 2: Hold breath 3 sec., retrieve objects, explore deep water, front & back float unassisted 5 sec,
level off from vertical position, 10 bobs, jump into chest deep water, flutter kicks front & back, back
crawl arm action, front and back crawl 5 yds, turn front to back and back to front.
Level 3: Retrieve objects, chest deep bobs, traveling bobs, jump into deep water, kneeling dive,
compact dive, front & back float 2 body lengths, front & back crawl 10 yds, elementary backstroke 10
yds, reverse directions on front and back, tread water 1 minute.
Level 4: Deep water bobs, rotary breathing, standing dive, elementary backstroke 10 yds, swim
underwater 2 body lengths, bob chest deep 25 yds, front & back crawl 25 yds, breast stroke 10 yds,
sidestroke 10 yds, flip turn at wall, tread water 2 minutes.
Level 5: Alternate breathing, stride jump, long shallow dive, diving from board, breast stroke 10 yds,
sidestroke 10 yds, swim underwater 3 body lengths, elementary backstroke 25 yds, front and back crawl
50 yds, open turn front & back, tread water 2 minutes, feet first surface dive.
Level 6/7: Jump tuck from board, front & back crawl 100 yds, breast stroke 25 yds, sidestroke 25 yds,
butterfly 10 yds, side stroke turn, breast stroke turn, speed turn, flip turn pike surface dive, tuck surface
dive, throwing rescue, swim under water 15 yds, retrieve diving brick.
Does your child have any of the following: Check if yes: Tubes in ears__ Epilepsy__ Asthma__
Allergies__(specify):________________ Diabetes__ Other____________________
Parent/Guardian signature______________________________________________
Checks payable to: Splashland LLC. Mail to: c/o Splashland, 5975 Griego Rd, Alamosa, CO 81101
☺☺☺ NEW Rates: Individual Rate >> $75. ~ Family Rate (2 or more) >> $70 each ☺☺☺
