• You have expressed interest in attending the Water Safety Program for CALD Women, Youth and Young Adults Please complete the form below.

  • PARTICIPANT REGISTRATION FORM

    For all participants - under 18's must have parent/guardian sign consent below

  • SECTION 1: PARTICIPANT DETAILS

    Please ensure your First and Last Names are recorded as they appear on your license or passport.
  • Gender*
  • Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: 0000 000 000.

  • SECTION 2: WATER COMFORT & EXPERIENCE FORM 

    Please select the option that describes your experience in water:
  • Have you ever been in a swimming pool before?*
  • Have you ever had swimming lessons?*
  • Can you put your face in the water without fear?*
  • Can you float or glide on your back in the water?*
  • How comfortable do you feel in the water?*
  • Can you swim?*
  • Can you swim across a pool (25 meters)?*
  • Do you need help understanding instruction in English?*

  • Do you have any cultural or religious considerations around clothing or participation in water activites?*
  • Which location will you be attending?*

  • As part of the swimming program, you will recieve a rash vest to wear, please select your rash vest size:*

  • SECTION 3: MEDICAL INFORMATION FORM

  • The following information is used by Surf Life Saving Tasmania to better uphold and manage the safety of students across the many programs we run. It also assists us in making adjustments to individual training needs where possible. You may feel that some of the questions asked of you are not relevant to the program you are enrolling in. If that is the case, you do not have to provide information you are not comfortable sharing. The only compulsory parts of this form are:

    • Your Personal Details
    • Your Emergency Contact
    • Your Signature & Dating of the Medical Form Declaration

    In saying that:

    • we assure you that your personal & medical information is only used in relation to the program you are enrolling in and will only ever be shared with Program coordinating staff and Emergency Services when applicable.
    • if you do not disclose an ailment, injury, illness or condition and it presents itself throughout a training program we cannot be held responsible and it may inhibit effective treatment.

  • YOUR PERSONAL DETAILS

  • Gender*
  • Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: 0000 000 000.

  • EMERGENCY CONTACT DETAILS

    Who is the best person to contact on your behalf in case of an emergency?

  • Format: 0000 000 000.

  • MEDICAL INFORMATION

  • Do you suffer from any of the following medical conditions?*
  • Do you take any regular or intermittent medications?*
  • Are you allergic to any drugs?*

  • Do you suffer from any fears/phobias (e.g. heights, confined spaces, water, etc)?*
  • Do you have any acute or chronic injuries that may affect you during the training?*
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Did you have any physical or mental disabilities?*

  • Your Medical Form Declaration 

    • The medical information you have provided will help our staff better assist you in the event of an accident or illness.
    • By signing the participant consent form you are acknowledging the information you have provided is accurate and truthful at the time of completion.
    • The information you disclose will be kept confidential, and will only be used to assist staff respond to a medical situation.

  • SECTION 4: PARTICIPANT CONSENT FORM

  • By signing this form: 

    • I confirm the information provided is accurate and truthful at the time of completion.
    • I understand that participation in water activities carries inherent risks.
    • I agree to follow all instructions provided by the instructors and lifeguards.
    • I acknowledge that the program is educational and not a professional swimming certification course.
    • I give permission for staff to seek emergency medical treatment if needed.
    • I am the parent/legal guardian of the participant named above and I give permission for them to participate in the Water Safety Program for CALD Women, Youth and Young People.
  • I consent to my photo/video being taken for promotional purposes (optional)*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: