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

2

Name of referral friend

First Name

Last Name

3

Name* This field is required.

First Name

Last Name

4

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. You are required to bring a photo ID on the first day of the course for proof of age for the full cert and recert. You can bring a student ID and a birth certificate if you do not have a passport.

Date

7

Parent/Guardian’s NameIf under 18 years old.

First Name

Last Name

8

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

YESNO

9

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

10

Lifeguard Course Date

February 18th and 19th 10am-8pm

March 25th and 26th 10am-8pm

11

Lifeguard Recert Course Date

February 19th 10am-8pm

March 26th 10 am-8pm