Adult Bronze Course Registration Form
Please fill out the form slowly and carefully to ensure all your details are correct. Course Dates: 9th & 10th November + 16th & 17th November 2024
Section 1 | Candidate Details
Candidate Name
*
First Name
Last Name
Candidate Gender
*
Male
Female
Intermediate
Prefer not to disclose
Other
DOB
*
-
Day
-
Month
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Candidate Mobile (If Applicable)
Please enter a valid phone number for the candidate ONLY
Candidate Email (If Applicable)
Please enter a valid phone number for the candidate ONLY
Please list any allergies, relevant medical history, or dietary requirements
*
Back
Next
Section 2 | Emergency Contact Details
Emergency Contact Name
*
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Email Address
*
*A copy of this form will be sent to this email address
Back
Next
Section 3 | Uniform Sizes
Please fill out even if you have uniform. All candidates will get a set of fresh new uniform
Male Patrol Shirt Size
*
XS
S
M
L
XL
Not Applicable
Male Patrol Short Size
*
26
28
30
32
34
36
Not Applicable
Female Patrol Shirt Size
*
6
8
10
12
14
16
Not Applicable
Female Patrol Short Size
*
6
8
10
12
14
16
Not Applicable
Unisex Long Sleeve Bronze Top
*
S
M
L
XL
XXL
Back
Next
Section 4: Social Media Consent
Photos from this course may be used and published on our public/private social media platforms. Do you consent for WBSLSC to use pictures and publish them on various social media platforms including, Facebook, Instagram, Club Website, Newspapers/Newsletters etc.
*
Yes
No
Back
Next
Section 5: WWCC
The Working with Children Check is a screening process for assessing or re-assessing people who work with or care for children in Victoria. Anyone over the age of 18 years, MUST have a WWCC to participate in club activities.
Please upload a picture of your WWCC
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Section 6: Terms & Conditions
More information will be provided by the course coordinators prior to the course. If you have any queries, please contact chiefinstructor@woolamaibeach.asn.au
*
Ok
Is all the above information correct? Incorrect/Misleading information could result in your registration being discarded, and your position offered to someone on the waitlist.
*
Ok
Back
Next
Payment
*
prev
next
( X )
Adult Bronze Course Registration Fee
$
275.00
AUD
Quantity
1
Credit Card
Submit
Should be Empty: