Naper Carriage Hill Swim & Racquet Club 

Swim Lesson Report Card 

1 

Meets Expectations 

2 

Emerging Skill 

3 

Unwilling to Try 

Level Five 

Swimmer ________________________________ 

Instructor ________________________________ 

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

Skills 

_____   Demonstrate a shallow dive from the side.                                        

_____   Demonstrate a shallow dive from the side, glide two body   lengths, and begin any front stroke. 

_____   Swim underwater for at least 15 yards. 

_____   Demonstrate a tuck and pick surface dive, submerging   completely. 

_____   Demonstrate a front float in deep water for at least 2 minutes. 

_____   Demonstrate a back float in deep water for at least 2 minutes. 

_____   Demonstrate a flip turn while swimming on front. 

_____   Demonstrate a flip turn while swimming on back. 

_____   Tread water for at least 2 minutes using two different kicks: scissor, modified, or   rotary kick. 

_____   Demonstrate freestyle for at least 50 yards. 

 _____   Demonstrate backstroke for at least 50 yards. 

_____   Demonstrate butterfly for at least 25 yards. 

_____   Demonstrate breaststroke for at least 25 yards. 

_____   Demonstrate elementary backstroke for at least 25 yards. 

_____   Demonstrate sidestroke for at least 25 yards. 

_____   Demonstrate a rescue with the shepherd’s hook 

Exit Skills Assessment (if applicable) 

_____   Dive into deep water, swim freestyle 50  yards with a flip turn, maintain a back float position for at least 2 minutes,   and swim backstroke for 50 yards with a flip turn. 

_____   Swim breaststroke for 25 yards, tread water for 2 minutes, and   swim elementary backstroke for 25 yards.   

Recommendation for next session: ________________________________ 

Instructor Signature: ____________________________________________ 

* Please retain this copy for your own reference. 

Instructor Comments