Leadership (LSS NS Course) Application Form

Leadership Application form

*This form is to be used when applying for a course conducted (offered) by the Nova Scotia Lifesaving Society Branch*
Name of Applicant*

First NameLast Name
Applicant Address*

Street Address

Street Address Line 2 (include apt # here if applicable)

CityState / Province

Postal / Zip Code
Applicant information*

LSS IDBirthdate YY/MM/DD
Applicant email*
example@example.com
Lifesaving Society Examiner CourseFirst Aid Instructor CourseNational Lifeguard Instructor courseInstructor Trainer CourseOther
I have reviewed the pre-requisites for this course in the current NS LSS Program Guide, and verify that I meet them*

For registration consideration please attach: proof of certification (if LSSID is not listed or earned outside of Nova Scotia, or another provider)

Cancelof

References who can speak to the applicants abilities in Instruction and/ or Evaluation. Or those who can confirm pre-requisites:
Reference #1*

First NameLast Name
Reference #1 Email*
example@example.com
Reference #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2*

First NameLast Name
Reference #2 Email*
example@example.com
Reference #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3

First NameLast Name
Reference #3 Email
example@example.com
Reference #3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

I name of the applicant have completed this application and confirm that its information is accurate to the best of my abilities.
Signature of Applicant*
Submission

Click the Submit button to complete this form and send a copy to the Nova Scotia lifesaving Society, if you are unable to complete electronically please print and email the form "Attention: Aquatic Program Specialist" to experts@lifesavingns.ca Your application once received will be reviewed and you will be provided with an email response to confirm registration or highlight further steps as soon as possible.
Should be Empty:

Leadership Application form