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2. 
3. Summer 2025 Adapted Swim Lessons

   Adapted lessons are provided to individuals with physical and cognitive disabilities. Swimmers will be taught swimming and lifesaving skills based on their ability and goals. The schedule coincides with the group lessons schedule. If a guardian chooses, they may be in the water with the child and receive verbal instruction from the teacher. Our goal is to provide a safe and comfortable environment for you and your child.

   In addition to completing this form, you must register for an Adapted Swim Lesson session in RecTrac, the online registration system.

   • Register in RecTrac

   For questions, email lessonsmanager@cityofdubuque.org or call 563-589-4263.

5. Swimmer's Name*
7. Swimmer's Age*
8. Swimmer's Birthdate*
   Swimmer's Birthdate
10. Parent/Guardian Name(s)*
11. Phone Number*
13. Email Address*
15. Address1
17. Address2
19. City
20. State
21. Zip
23. The swimmer needs assistance with the following:*

    1. Following directions / communication
    2. Feeling comfortable in the water
    3. Putting head under the water
    4. Blowing bubbles in the water
    5. Floating
    6. Arm circles / forward motion
    7. Kicking in the water

    Check all that apply.

25. The goal for the swimmer is to be able to:*
27. Do you have any special requests or other information you would like to share?
29. Which pool do you prefer?*
    -- Select One --Flora PoolSutton Pool
31. Which session do you prefer?*
    -- Select One --June 10 - June 20June 24 - July 5 (no class July 4)July 8 - July 18July 22 - August 1
33. Which time do you prefer?*
    -- Select One --9 - 9:40 a.m.10 - 10:40 a.m.11 - 11:40 a.m.5 - 5:40 p.m.6 - 6:40 p.m.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field