Clone of Southern Region Starfish Nippers Registration Form 2025

Kingston Beach Starfish Nippers Registration Form 2026

Please register to participate in our free Starfish Nippers sessions being run by Kingston Beach Surf Life Saving Club. There will be 1-on-1 instructor-to-participant ratio, with a set number of participants per group available. Please register early to avoid disappointment! These sessions are family oriented, so we encourage siblings to come along - however will need to know in advance, so please list their details in the form below. 3 sessions will be available this summer at Kingston Beach and the program is open to all ages.
Starfish Nipper Information
Name (Starfish Nipper)*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Suburb*
Parent/Guardian Contact Details
Parent/Support person's name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to starfish nipper
Session attendance

We would love to see you at all sessions as we will be building on skill development but we understand life is busy so please sign up to the sessions that suit you and your family.
Session 1
Session 2
Session 3

Is your starfish nipper bringing along any siblings to the session? If they are, please list their name/s and age/s so we can best support them on the day.

	Full Name	Age
Sibling
Sibling
Sibling

Starfish Nippers Participant Profile

To enable our volunteers to best meet your childs needs and expectations of the Starfish Nippers program we ask that you complete the following questions for us to be able to create a 1-page Profile for each Starfish Nippers Participant. The aim is to gather information about your child in a very easy way. It enables a method of familiarisation prior to arrival at the beach which builds on positives and is very practical. This profile will not replace the normal process between your child and volunteer of getting to know each other but it will give both individuals a head start in building a good relationship.
Attach a photo of your child*

Cancelof
My medical diagnosis is...*
Please provide details to enable us to support your child ...*
I am good at...*
I sometimes need support with...*
I like...*
I feel worried or upset when...*
My primary form of communication is... (please select)*

VerbalAAC (eg- LAMP, PODD)Other
Mobility*

I can walk fully unaided across the sand and into the waterI require assistance to walk across the sand and into the waterI require a beach wheelchair for the entirety of the sessionI require a beach wheelchair for transport across uneven ground
Is there any other information you would like us to take into account when partnering a lifesaver with your child (e.g. male/female buddy, 2 buddies are required, carer will be present on day etc
Media Consent. We love taking photos on the day of our buddies and starfish nippers. Please outline below if you consent for your child to be photographed on the day*

Yes, I consent for photos to be taken on the dayNo, I would prefer no photos be taken of my child/ren
Should be Empty:

Kingston Beach Starfish Nippers Registration Form 2026