Beach to Bush Registration Form

Registration Form

Applications Close 5:00pm Friday 16th August

School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select the municipality that your school is under

Break O’DayBrightonBurnieCentral CoastCentral HighlandsCircular HeadClarenceDerwent ValleyDevonportDorsetFlindersGeorge TownGlamorgan Spring BayGlenorchyHobartHuon ValleyKentishKing IslandKingboroughLatrobeLauncestonMeander ValleyNorthern MidlandsSorellSouthern MidlandsTasmanWaratah-WynyardWest CoastWest Tamar
Primary Contact Name*

First NameLast Name
Contact E-mail*
example@example.com
Contact Number*
Total Number of Students in Year 1 & 2*
School Day Scheduling

We have scheduled to visit schools in area groups on specific dates, but where possible we will try to work around your availability.
Southern District

16th October - 8th November

Northern District

11th - 29th November

Western District

2nd - 18th December
Preffered Weekday(s)*

MondayTuesdayWednesdayThursdayFridayAll of the Above
School Time Schedule

Please provide the set times of a school day
School Start & Finish Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
First Break*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Second Break*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Any Further Comments
Media Consent

On occasion Surf Life Saving Tasmania engages various media to help promote the program and respective water safety messages. Please select your preference.
Please Select an Option*

The school consents for SLST to take photographsThe school consents for SLST to engage the MediaThe school DOES NOT consent to Photography and Media
Any further information we should know?*
Should be Empty:

Registration Form

School Day Scheduling

School Time Schedule

Media Consent