Naper Carriage Hill Swim & Racquet Club 

Swim Lesson Report Card 

Level Four 

1 

Meets Expectations 

2 

Emerging Skill 

3 

Unwilling to Try 

Swimmer ________________________________ 

Instructor ________________________________ 

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

Skills 

_____   Demonstrate a dive from a compact position on the side of the pool. 

_____   Demonstrate a dive from a stride position on the side of the pool. 

_____   Swim underwater for at least three body lengths. 

_____   Demonstrate a feet first surface dive and submerge completely. 

_____   Demonstrate a front float in deep water for at least 1 minute. 

_____   Demonstrate a back float in deep water for at least 1 minute. 

_____   Demonstrate an open turn using any stroke on front and pushing  off in a streamline position. 

_____   Demonstrate an open turn using any stroke on back and pushing  off in a streamline position. 

_____   Tread water using a modified scissors, breaststroke, or rotary  kick and arm motions. 

_____   Demonstrate freestyle for at least 25 yards. 

_____   Demonstrate backstroke for at least 25 yards. 

_____   Demonstrate butterfly for at least 15 yards. 

_____   Demonstrate breaststroke for at least 15 yards. 

_____   Demonstrate elementary backstroke for at least 15 yards 

_____   Swim on side using scissor kick for at least 15 yards. 

_____   Demonstrate a throwing assist using the ring buoy. 

_____   Discuss rules for safe diving. 

_____   Discuss water safety rules and demonstrate how to get help. 

Exit Skills Assessment (if applicable) 

_____   Perform a feet first entry into deep water, swim freestyle for  25 yards, float on back for 1 minute, and swim backstroke for 25  yards.  All MUST be completed consecutively without   interruption.  

_____   Swim breaststroke 15 yards, tread water for 1 minute, and swim elementary                backstroke for 15 yards swim without interruption.   

Recommendation for next session: ______________________________ 

Instructor Signature: __________________________________________ 

* Please retain this copy for your own reference. 

Instructor Comments