PATROL HOURS EXEMPTION REQUEST / LATE PROFIECIENCY REQUEST

SURF LIFE SAVING QUEENSLAND

PATROL HOURS EXEMPTION REQUEST / LATE PROFICIENCY REQUEST
Members are to complete the below form and have endorsed by your Club Executive/Management Committee and submit to your Branch. This is for the use of competitive members ONLY.
Name of competitor*

First NameLast Name
Email of competitor*
example@example.com
Branch*
Club - NQB*
Club - NBB*
Club - WBC*
Club - SSCB*
Club - SCB*
Club - PDB*
Name of person completing this form

First NameLast Name
Club Role/Position
Email of person completing this form
example@example.com
Please indicate what you are applying for:*

Patrol Hour ExemptionLate Skills MaintenanceBoth (Patrol Hour and Late Skills Maintenance Exemption)
PATROL HOURS EXEMPTION REQUEST
Patrol Hour Exemption Request - Please outline the reasons behind your inability to perform the required patrol hours. Please note that proof must be provided for any reason listed.*

Medical Reason (please attach doctors certificate. This MUST include a clearance date for return to normal duties))International Employment (please attach employment & flight records)Fly in Fly Out Employment (please attached employment records/roster)Member of the Armed Services (please attach proof)Returning Member (we will verify this via the membership database)Other
If other, please indicate reason*
File Upload*

Cancelof
Please attach a record of your Patrol Hour History from the previous three seasons. This information can be found in your members portal.
File Upload*

Cancelof
LATE SKILLS MAINTENANCE (PROFICIENCY) REQUEST
Late Skills Maintenance Request - Please outline the reasons behind your inability to perform the required patrol hours. Please note that proof must be provided for any reason listed.*

Medical Reason (please attach doctors certificate. This MUST include a clearance date for return to normal duties))International Employment (please attach employment & flight records)Fly in Fly Out Employment (please attached employment records/roster)Member of the Armed Services (please attach proof)Returning Member (we will verify this via the membership database)Other
If other, please indicate reason*
File Upload*

Cancelof
VOLUNTARY DUTIES

Duties relating to the Club’s operations that the Club recognises in lieu of patrol hours. Clubs seeking competition eligibility for members under this option must apply through their Branch/State Centre
Other - Please outline the reasons behind your inability to perform the required patrol hours. Please note that proof must be provided for any reason listed.*

Medical Reason (please attach doctors certificate. This MUST include a clearance date for return to normal duties))International Employment (please attach employment & flight records)Fly in Fly Out Employment (please attached employment records/roster)Member of the Armed Services (please attach proof)Returning Member (we will verify this via the membership database)Other
Club Endorsement
I declare that the information provided in this application is true and correct. I also acknowledge that the Branch or SLSQ may contact me or others to determine the validity of my application.

I further acknowledge that I am required to adhere to the rules, regulations and policies of the Branch, SLSQ and SLSA as it relates to patrol hours and proficiency requirements and will adhere to the decision made relevant to this application.
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

SURF LIFE SAVING QUEENSLAND

Club Endorsement