LIFEGUARD CERTIFICATION CLASS REGISTRATION

Must be at least 15 years old to apply

Please read all Important Class Information thoroughly before submitting. It is important that all applicants understand the course requirements.

NAME: * First Last
BIRTHDATE / MM / DD YYYY
CELL PHONE * - ### - ### ####
ADDRESS: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
IMPORTANT CLASS INFORMATION
Have you ever been lifeguard certified? *
Yes, certification current Yes, certification expired No
If yes, CERTIFICATION NUMBER:
CERTIFICATION EXPIRATION DATE:
It is required by Red Cross that students attend and participate in ALL class sessions at the specified times. *
I understand that I must attend and participate in all class sessions.
Class dates and times are subject to change. The instructors try to be as flexible as possible and still provide quality training and certifications. Students need to make every effort to be flexible as well to insure they have the best chance at passing the certification class.
It is required by Red Cross that students must complete ALL online blended learning content BEFORE the first day of class in order to participate in any in-class sessions. *
I understand that I must complete ALL online blended learning content BEFORE the first day of class. If I do not complete the online content, I cannot participate in the first day of class, therefore, I will not be able to fulfill the requirement to attend and participate in ALL class sessions.
You will be required to show proof that all online material has been complete.
Email address:
Please provide an email address that is easily accessible. This address will be used to send you the link for the online blended learning content that must be completed prior to the first day of class. *
Entry into an American Red Cross Lifeguard Certification course requires students to complete a Pre-Course Skills Evaluation.

By checking each box, I understand each requirement and I agree that I must complete all 3 in order to be accepted into the class. (In the event a requirement is not met, the student will be allowed a second and final attempt to complete the requirement) *
300 yard continuous swim demonstrating rhythmic breathing and proper stroke competencies. Timed Brick Event-participant has 1 min, 40 secs to swim 20 yards, retrieve a 10lbs brick at a depth of 7-10 feet, return to the surface and swim back to the starting point with both hands on the brick and keeping the face at or near the surface of the water. Tread water for 2 mins using only the legs, no hands.
By signing below, I understand that:

I must successfully complete the Pre-Course Skills Evaluation

I must participate and pass practical skill scenarios as a group as well as an individual.

Written exams for CPR/AED/First Aid and Lifeguarding Skills must be passed with a score of at least 80%.

100% course attendance is mandatory.
APPLICANT SIGNATURE: *

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LIFEGUARD CERTIFICATION CLASS REGISTRATION

LIFEGUARD CERTIFICATION CLASS REGISTRATION

IMPORTANT CLASS INFORMATION