Registration / Medical Review 2021
Thank you for choosing Watch Me Swim. You are registering for lessons with Jaime Brownlee. 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 (if applicable) is required in advance. Lessons are reserved on a first come first serve basis. If payment is not received within 3 days of submitting this form, your requested date and time will be given to the next paid student. Early registration is highly recommended to avoid being put on a waiting list. For additional payment information please visit: http://watchmeswim.com/tuition.html
Private Residence, 2804 Kimmi Tree Lane, Valrico, FL 33594
Email: WatchMeSwimValrico@gmail.com for availability information.
Student One Information
Student's Last Name
Student's First Name
Age in months:
Date Of Birth:
Must be atleast 6 months of age.
Name of Child's Daycare or Preschool
Choose Level That Fits Best
1st Year New Student - No formal lessons
1st Year New Student - Previous lessons at another program
Refresher student from Watch Me Swim - had lessons last year
3rd+ Year refresher student from Watch Me Swim
Advanced Stroke Lessons - Age 5 or older and can swim/float/swim
Not Sure - None of the above fit my child's skill level
Please Describe All Previous In Water Experience
Start Date and Lesson Time
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.
Student One Health Information
Name of Student's Pediatrician or Primary Health Care Physician
This Student Ever Been Seen By A Medical Specialist Other Than His Pediatrician?
If Yes, Please Explain & Include Date of Last Visit
Does this student have any health issues or concerns such as allergies, current medications, therapy, history of seizures, etc.
If Yes, Please Explain
Will You Be Registering A 2nd Student?