Making waves: Vision Australia’s Swim Smart Day Expression of Interest form Vision Australia. Blindness and low vision services

Please submit your expression of interest by Sunday, November 23.

Questions marked with an asterisk are mandatory.

Family details

Child's name:*

Child's date of birth:*

Your name and relationship to the child:*

Your contact phone number:*

Your email address:*

Your child's swimming experience

Has your child had any experience with swimming or water play? Please describe:*

How comfortable is your child in and around water?*

Can your child float, kick, or move in the water?*

Has your child attended swimming lessons before? If yes, where and when?*

Goals and interests

What do you and your child want to achieve through this program?*

Are there particular skills or goals you’d like us to focus on (for example, water confidence, floating, swimming strokes, water safety)?*

Is your child interested in swimming for recreation, safety, fitness, or to join a club or competition?*

Communication and support

How does your child communicate (for example, speech, sign, tactile, device)?*

Are there any communication supports or strategies we should use?*

Are there behavioural or sensory triggers we should know about?*

What helps your child feel calm and supported in new situations?*

Health and medical information

Does your child have any medical conditions we should know about?*

Has your child had recent surgery, illness, or infections?*

Does your child have a history of seizures, cardiac conditions, or other medical issues?*

Does your child have any skin conditions, wounds, or infections?*

Is there any risk of retinal detachment?*

Does your child use any medications that need to be given during the day?*

Does your child have any tubes or medical devices (for example, catheters, feeding tubes)?*

Does your child experience incontinence? If so, how is this managed in a pool?*

Physical access and assistance

Does your child use a wheelchair, mobility aid, or require ramp access?*

Will your child need help with dressing, toileting, or getting in and out of the pool?*

Will a parent, carer, or support person be getting into the pool? If yes, do they have any health or mobility needs?*

Here are my questions for Vision Australia:

Consent

By submitting this form you agree to the following:

You confirm you have shared relevant health and safety information.
You give consent for your child to participate under the shared supervision of yourself and Vision Australia staff.
You understand that if certain conditions are present, medical clearance may be required before participation.

Privacy policy

By submitting this form, you confirm that you agree to the storing and processing of your personal data by Vision Australia as described in our Privacy Policy.

The information you have submitted will be used to provide you with the most relevant content on Vision Australia services, news & events, and other opportunities for support.