Child's Name:

Current Level:

Class Day / Time / Instructor:

Assessed By:

Streamline kicks 7 yd. on front

Streamline kicks 7 yd. on back

Swims backstroke 15 yd. (Thumbs out - Pinky In)

Swims freestyle 15 yd. WITH roll breathing

Whip Kicks (Full Whip Kick with feet turned out - no pointed or floppy feet)

Butterfly Arms - Sneaky Butterfly Arms (Thumbs Down Swing Around - Arms moving at same time)

Rotary breathing with equipment

Comments / Corrective Actions:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.