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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. Renewal/ Review Class

  6. Full Lifeguard Course

    April 9. 5:30-8:30 is a pretest swim and class information session- participants under 18 must have signed registration and SPLASH agreements to participate

  7. Would like to participate in SPLASH program?*

  8. Participant will be 16 years of age before June 11 2020?

  9. Cost of Courses

    If you are not a participant in the SPLASH program the cost of certification: $250 for Full Course, $125 for Renewal/ Review Course

  10. 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).

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

  12. Leave This Blank:

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