Aquatic Service Enrolment Form

Background information on water skills

Aquatic Goals

Behaviour Support Needs

Communication Information

Expressive (please select any that apply)

Spoken Words

Sign (BSL, Auslan, KWS)

PECS

Communication App

Receptive (please select any that apply)

Spoken Words

Sign (BSL, Auslan, KWS)

PECS

Communication App

Sensory Support Needs

Sensory averse - is there anything in the aquatic environment the participant is likely to find aversive and try to avoid? (please select any that apply)

Bright Lights

Being Touched

Loud Noises

Chlorine Smell

Splashing Water

Being Underwater

Wearing Goggles

Wearing Swimming Cap

Sensory seeking - is there anything in the aquatic environment the participant is likely to find enticing and try to seek out? (please select any that apply)

Swallowing/Gulping Water

Splashing Water

Making Loud Noises

Being underwater

Seeking Touch

Bright Lights

Jumping In The Water

Spitting Water

Behaviour	Where does this behaviour usually occur?	How often does the behaviour usually occur?
		Hourly	Daily	Weekly	Monthly
		Hourly	Daily	Weekly	Monthly
		Hourly	Daily	Weekly	Monthly
		Hourly	Daily	Weekly	Monthly

Aquatic Service Enrolment Form

Participant Information

Parent / Guardian 1

Emergency Contact Information

Background information on water skills

Aquatic Goals

Behaviour Support Needs

Communication Information

Expressive (please select any that apply)

Receptive (please select any that apply)

Sensory Support Needs

Sensory averse - is there anything in the aquatic environment the participant is likely to find aversive and try to avoid? (please select any that apply)

Sensory seeking - is there anything in the aquatic environment the participant is likely to find enticing and try to seek out? (please select any that apply)

Additional Information

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