Seahorse Nippers About Me Form
Tell us about your participant so we can match them with the best lifesaver for their needs. Please contact the surf club via 07 5448 0900 or membershipdevelopment@noosasurfclub.com.au if you need any assistance with your membership or if you have any queries regarding the program.
Participant Name
*
First Name
Last Name
Participant Date of Birth
*
-
Day
-
Month
Year
Date
Parent/ Guardians Name
*
First Name
Last Name
Parents/ Guardians Email
*
example@example.com
Parent/ Guardians Phone Number
*
Please enter a valid phone number.
Photo of your Participant
*
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Which Surf Club are you currently a member of?
Has your Club completed the Reciprocal Rights form on your behalf? If no, please ask them to complete by the registration closing date.
*
Yes
No
If your participant is aged 18+ they are required to hold a current Working with Children Blue card, along with completing the SLSA Child Safe and SLSQ Child and Youth Risk Management Strategy online courses. Is your participant able to undertake this requirement?
Yes
No
If you answered no to the above, please confirm that the participant has not been in child related work for more than 7 days per calender year or associated with surf life saving events for the same period of time.
Yes
No
Click here to apply for a Blue Card -
Bluecard Services
Which program dates will you be attending for the 2023/2024 season?
*
2nd March 2024 (Program 3)
I have? (condition)
*
It affects me :
*
I am good at :
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I am not good at :
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I like :
*
I dislike :
*
I become scared when :
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I become upset when :
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What calms me?
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My verbal communication is
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Very chatty, I will talk all day long
Somewhat chatty, I can tell you what I'm feeling
Somewhat quiet, I can struggle with telling you how I feel, but I can say some words
Very quiet, I don't speak
How can you help me understand?
*
I am sensitive to noise/sound?
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Yes
No
I do my best when :
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I am happiest when :
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I like to be praised or rewarded by :
*
What motivities me?
*
When I'm upset I need :
*
Swimming and Water Abilities
This section is to help our lifesavers understand your particpant water confidence and ability.
Does your participant like the water?
*
Yes
No
Can your participant swim?
*
Yes
No
Can your participant confidently hold onto a floating object (pool noodle)?
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Yes
No
Can your participant float on their back?
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Yes
No
Can your participant put their face in the water?
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Yes
No
Can your participant wear a lifejacket? (It will hug their body tightly)
*
Yes
No
Can your participant doggy paddle?
*
Yes
No
Lifesaver Preferences
Tell us about who you would prefer to assist your nipper?
Is there any preference to who you would like to assist your participant? Male/female, young person/ adult, 1 or 2 carers?
Will you have a carer available to assist with your nippers participant? If yes, please supply the carers full name, blue and yellow card details.
Please note that by joining the Seahorse Nippers program as a reciprocal rights member you are consenting use of images for use in social media and advertising for the Noosa Heads Surf Life Saving Club. If you do not wish to share these images please contact the surf club to complete a photo non consent form.
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