Naper Carriage Hill Swim & Racquet Club 

Swim Lesson Report Card 

1 

Meets Expectations 

2 

Emerging Skill 

3 

Unwilling to Try 

Level Three 

Swimmer ________________________________ 

Instructor ________________________________ 

All 1’s are required to proceed to the next level 

Skill                                                                                

_____   Jump into deep water from the side.                          

_____   Demonstrate a head-first entry from the side in a sitting or  kneeling position. 

_____   Submerge and independently retrieve an object from chest  deep water in three seconds or less. 

_____   Bob with head fully submerged in chest deep water at least  5 times. 

_____   Demonstrate rotary breathing with body in a horizontal position  at least 5 times. 

_____   Demonstrate a front glide using at least two different kicks,  each for two body lengths. 

_____   Demonstrate a front float in deep water for at least 30 seconds. 

_____   Demonstrate a back glide using at least two different kicks,              each for two body lengths. 

_____   Demonstrate a back float in deep water for at least 30 seconds. 

_____   Change from a vertical to a horizontal position on front. 

_____   Change from a vertical to a horizontal position on back. 

_____   Tread in deep water, using hands and leg movements for at 

 least 30 seconds. 

_____   Demonstrate freestyle for at least 15 yards. 

_____   Demonstrate backstroke for at least 15 yards. 

_____   Demonstrate butterfly kick and body motion for at least   15 yards.  

_____   Demonstrate a reaching assist with the ring buoy. 

_____   Discuss how to call for help 

_____   Discuss rules for safe diving. 

Exit Skills Assessment (if applicable) 

_____   Jump into chest-deep water from the side, swim freestyle  for 15 yards with face in the water and breathing rhythmically  either to the front or the side, maintain position by treading or   floating for 30 seconds, and return to the side using a backstroke.  All MUST be completed without hesitation or interruption. 

Recommendation for next session: _______________________________ 

Instructor Signature: ___________________________________________ 

* Please retain this copy for your own reference. 

Instructor Comments