subject_line
Registration / Medical Review 2023
Riverview Location With Kari Bahour
Thank you for choosing Watch Me Swim. You are registering for lessons with Kari Bahour. All information is strictly confidential and will never be shared with another party.
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 first week's lesson fee and registration fee is required at the time of submitting this form. Time slots will not be reserved without payment. Lessons are reserved on a first come first serve basis. If payment is not received at the time of registration, 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.
Fees & Tui
ti
on
(due at the time of completing this form)
:
$100 Weekly Tuition (4 private one-on-one lessons weekly)
$ 90 New Student Registration Fee
$ 25 Returning Student Registration Fee
Location is on a private acre lot
:
11501 McMullen Road, Riverview 33569
(Between Balm Riverview Road & Boyette Road, just north of the Kids Community College - Southsore).
The pool is heated with water temperature remaining between 86-88 degrees
.
General Availability:
February - March: 9:30 a.m. - 12:40 p.m. and 3:00 p.m. - 6:30 p.m.
April - September: 7:00 a.m. - 12:40 p.m. and 3:00 p.m. - 6:30 p.m.
October - November: 8:00 a.m. - 12:40 p.m. and 3:00 p.m. - 5:30 p.m.
Student One Information
Student's Last Name
*
Student's First Name
*
Age in months/yrs:
*
Date Of Birth:
Must be atleast 6 months of age and be able to sit unassisted.
*
Gender
*
Male
Female
What Age Did This Child Sit Up Unassisted?
*
Does this child attend daycare/preschool either full time or part time?
*
Yes
No
Name of Preschool/Daycare:
Please Describe All Previous In Water Experience
*
🛈
0/300 characters
Choose Level That Fits Best
*
1st Year New Student - No formal lessons
1st Year New Student - Previous lessons at another program
2nd Year Refresher student from Watch Me Swim - had lessons last year
3rd+ Year refresher student from Watch Me Swim
Not Sure - None of the above fit my child's skill level
General Availability
February - March: 9:30 a.m. - 12:40 p.m. and 3:00 p.m. - 6:30 p.m.
April - September: 7:00 a.m. - 12:40 p.m. and 3:00 p.m. - 6:30 p.m.
October - November: 8:00 a.m. - 12:40 p.m. and 3:00 p.m. - 5:30 p.m.
Click on the calendar to choose your preferred start date. All lessons start on a Monday.
*
+
Choose your preferred lesson time using a 10 minute interval. Example: 11:10, 11:20, 11:30, 11:40, etc.
Lesson times must be conducive for Monday - Thurday.
Different times for different days are not available.
*
Scheduling Comment?
Student One Health Information
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
0/300 characters
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
0/300 characters
Will You Be Registering A 2nd Student?
*
Yes
No