BAC Lifeguard Course Sign-up Form

1

How did you hear about our lifeguarding course?* This field is required.Select all that applies.

BAC website

BAC email

BAC Facebook

BAC Instagram

Friend

Other

2

Name of referral friendPlease complete this section if someone referred you to this class. Your referral will receive $10 off the course if they attend your same course on the same day.

First Name

Last Name

3

Student's Name* This field is required.

First Name

Last Name

4

Student's Email* This field is required.This will be the email linked to your American Red Cross account.

example@example.com

5

Phone Number* This field is required.

Please enter a valid phone number.

6

Date of Birth* This field is required.Please note: If taking the full lifeguarding course, you must be 15 years old by the last day of the course and 17 years old by the last day of the recert course. You are required to bring a photo ID with your birthdate on the first day of the course for proof of age for the full cert and recert courses. You can bring a student ID and a birth certificate if you do not have a passport or driver's license.

Date

7

Parent/Guardian’s NameSkip if 18 years old or older.

First Name

Last Name

8

Parent EmailPlease skip if 18 years or older.

example@example.com

9

Parent/Guardian’s Phone NumberSkip if 18 years old or older.

Please enter a valid phone number.

10

Do you have an expiring lifeguarding certification?* This field is required.

YESNO

11

Please upload your expiring Lifeguard CertIf your cert expired over 30 days by the last day of the course, you will have to redo the full lifeguarding course.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

12

Lifeguard Course Date

November 22nd and 23rd, 10 am to 9 pm

December 20th and 21st, 10 am to 9 pm

13

Lifeguard Recert Course Date

November 22nd 10 am to 7:30 pm

December 20th 10 am to 7:30 pm