Thank you for choosing Watch Me Swim, LLC. You are registering for lessons with Instructor Michelle Potts. All information is strictly confidential and will not be shared with a 3rd party.

General Availability: Please email Michelle@watchmeswim.com for availability information before completing this form.

WMS Registration Fee: $90 paid one-time per new student.

$30 paid annually for each returning student after the 1st year.

All registration fees must be paid online to Watch Me Swim, LLC and are non-refundable.

Weekly Tuition: $120 per child, per week.

Paid directly to Michelle Potts

BEFORE YOU BEGIN: Due to the high volume of families served each year and in order to better streamline the scheduling process, payment of the WMS Registration Fee is required at the time of submitting this form. Lessons are reserved on a first come first serve basis. If the WMS registration fee is not received at time of submitting this form, your requested start date and lesson time will be given to the next paid student. Early registration is highly recommended to avoid being put on a waiting list.

Student's Last Name *

Student's First Name *

Age in months/yrs: *

Date Of Birth:
Must be atleast 6 months of age. * +

Gender *

What age was this child able to sit unassisted? Students must be able to sit independently to be enrolled in WMS self-rescue swim lessons. *

Choose Skill Level That Fits Best *

Please Describe All Previous In Water Experience * 🛈

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T-shirt Size *

Child's Favorite Toy or Character *

Does this child attend daycare/preschool either full time or part time? *

Yes

No

Name of Preschool/Daycare:

Scheduling Requests/Comment? *

Name of Student's Pediatrician or Primary Health Care Physician *

Has This Student Ever Been Seen By A Medical Specialist Other Than His Pediatrician? *

Yes

No

If Yes, Please Explain & Include Date of Last Visit

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Does this student have any health issues or concerns such as allergies, current medications, therapy, history of seizures, etc. *

Yes

No

If Yes, Please Explain

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Will You Be Registering A 2nd Student? *

Yes

No