Operation Splash Program Lifeguard Certification Operation Splash 2025

Operation Splash Program Lifeguard Certification Operation Splash 2025

Operation Splash Application Instructions
This application is being used to verify applicant's eligibilty to receive a scholarship for Operation Splash, a grant funded program offered through Kaiser Permanete's " Healthy Eating Active Living" Program. This scholarship covers a FREE American Red Cross Lifeguard Certification through Desert Recreation District.

Operation Splash is designed to provide aquatics programming to interested applicants in order to provide access to employment through Desert Recreation District. Each qualified applicant is eligable for ONE FREE certification course.

Please follow the instructions below to ensure timely processing of your application:

Step 1- Each particpant must complete a seperate application.

Step 2 - Please provide all contact information requested on the application, if any contact information is incorrect we will not be able to contact you about your application.

Course Desciption:

Each lifeguard course consists of three days of training. To complete this course, each participant must attend all three days and successfully complete each component of the course. Participants will be expected to swim 300 yds, tread water for 2 minutes, and perform a 10 pound water retrieval test at the beginning of the course. Please bring a swim suit, towel and goggles on Friday.

Operation Splash Program Lifeguard Certification Operation Splash Program 2025

Application and Income Certification Form Kaiser Permanente Foundation
Operation Splash Application Form

Fill out form carefully - one application for each participant.
Student Name*

First NameLast Name
Birth Date*

DayMonthYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email*
example@example.com
Does participant qualify for his/hers school 's free and reduced lunch program*

YesNoNot Applicable
Total family income - Please list income from all sources.
File Upload-Required individuals NOT participating free and reduced lunch program. To accurately determine your household income you must upload approved documents for income verification. 2 current pay stubs or 2024 W2 or TAX RETURNS or unemployment and or workers compensation or Social Security or child support or alimony checks . *

Cancelof
Signature

Limpiar
Should be Empty:

Operation Splash Program Lifeguard Certification Operation Splash Program 2025