SLSQ Special Event Application Form

SLSQ Special Event Application Form
When submitting the application:

PLEASE NOTE: The form is to be submitted by the Surf Club/Branch/Service only and not by the event organiser. 1. Forms must be submitted a minimum of 14 days prior to your event. 2. Be clear and concise with the information you are providing and what is required. 3. Attach all relevant documentation relating to your event eg, certificate of currency, approvals and risk management documents 4. Special event coverage does not extend to non SLS members under the SLS National Insurance Program
Section 1- Apply Surf Club/Service
Name of applying Surf Club/Service
Branch
Contact Person Name*

First NameLast Name
Contact Person Email*
example@example.com
Contact Person Mobile*
Format: 0400 000 000.
Contact Persons Position*
YesNo
YesNo
YesNo
Section 2- Event Details
Name of the Event*
TriathlonSwimCommunity Awareness School Beach ProgramTraining Program for Non MembersFundraisingFirst AidAquatic Supervision- PoolCome and Try Day- Nippers, Surf Boat, ClubSurf Club/Branch CampNon Qualified Person in an IRBCommunity DisplaySurf Club Run EventSurf Club Run Event - Aquatic ActivityYouth ActivityWater Safety for an Event
Start Date of the Event*

DayMonthYear
Date
Hour MinutesAM/PM Option
End Date of the Event*

DayMonthYear
Date
Hour MinutesAM/PM Option
Event Location*
At most two sentences.
Description of Level of Involvement and expectations*
At most two sentences.
Number of Participants expected at the Event
Event Organiser *
Organiser Contact Name*

First NameLast Name
Organisers Contact Number
Format: (000) 000-0000.
Organisers Email*
example@example.com
Organisers/Locations Public Liability Insurance*

Cancelof
Organisers Event Safety and Risk Management Document*

Cancelof
Event Map*

Cancelof
Event Council Permit*

Cancelof
Event MSQ Permit

Cancelof
Camp Program/Activities

Cancelof
Training Program

Cancelof
YesNo

Name and Contact Number of the Event Safety Officer/Water Safety Coordinator*
Section 3- SLS Members
Total Number of SLS Members Involvement
Section 4- Safety Equipment

Section 5- Additional Information

Please upload any additional documents relevant to the event, or use the additional information section to provide further details if required.
Further Information Relating to the Event
Additional Information Documents

Cancelof
I confirm that all information provided is true and correct to the best of my knowledge. I acknowledge that by participating in this activity, all Surf Life Saving members are required to comply with all relevant SLSA and SLSQ policies and procedures at all times.
Signature*

Clear
Date

DayMonthYear
Date
Should be Empty:

Rows	Details
Aquatic Distance
Course Shape
Number of participants in the water at one time
Water Safety Ratio

Rows	Number Of
IRB
RWC
Rescue Boards
Rescue Tubes
First Aid Kit/Oxy Viva Unit
Defib
SSV
Vehicle
Drone
Radios
Ski
Other

SLSQ Special Event Application Form

When submitting the application:

Section 1- Apply Surf Club/Service

Section 2- Event Details

Section 3- SLS Members

Section 4- Safety Equipment

Section 5- Additional Information