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Lifeguard Class Registration

  1. Participant Information

  2. Parent/ Guardian Information (Complete if participant is a minor)

  3. Emergency Contacts (please indicate 2)

  4. Which Certification do you need *

  5. Would like to participate in SPLASH program?*

  6. Participant will be 16 years of age before June 30, 2021

  7. Waiver of Liability/ Photo

    Liability Waiver: I am/my child is participating in the American Red Cross training program and I release, absolve, clear, hold harmless and waive the responsibility of the City of Winston-Salem, Recreation and Parks Department, Staff and Volunteers of risks and hazards incidental to the implementation of this program. Photo Waiver: By participating in this public program, the participant (parent/guardian) acknowledges and gives permission for his/her (child/dependent) image/likeness to appear in group photos used by WSRP in promotional material (printed and/or social media).

  8. Type name of person who agrees to the above liability waiver- a signature will be required at the first class meeting

  9. Leave This Blank:

  10. This field is not part of the form submission.