Lifeguarding Recertification Registration Form

Lifeguarding Recertification Registration

Fill out this form to register for the lifeguarding recertification course. By submitting payment and registering for the Lifeguarding Recertification Course, the participant confirms they have read, understood, and agreed to all of the terms and conditions.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Additional Comments

My Products*

Lifeguarding Recertification Course

Choose this option if you currently hold a lifeguarding certification and you are renewing it. Please select quantity as 1 and ensure your total matches the price of the course.

$52.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

You must upload your current lifeguarding certificate here to be enrolled in the course. Failure to do so will result in unenrollment from the course with no refund. *

Cancelof
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