Clone of SLSSA SMAR Application

SMAR - Application

March/April 2026
Participant Details
Name*

First NameLast Name
Birth Date*

DayMonthYear
Gender*
E-mail*
Mobile Number*
SLSSA Club: *
Are you: *
What year at school are you in this year:

Year 10Year 11Year 12Not at School
SMAR Requirements

Please confirm that you meet the prerequisites of the course, which course you would like to attend and your motivations for wanting to gain the award
I can confirm that I meet the prerequisites of the course:

Bronze ProficientFinancial Club MemberAt least 16 years old at the time of the assessmentCan meet the swim requirement of 400m in 8mins or less
Please confirm that you are available for each session of the SMAR Course:*

Pool Session plus assessment: Tuesday 31st March, 6:30pm - 8:45pmTheory & Night Search assessment: Saturday 11th April, 2pm - 10pmWet Session plus assessment: Sunday 12th April, 8:30am - 1pm
Brief explanation of why you would like to obtain the SMAR award:*
Club Support

Please provide the details of your Club Captain, Chief Instructor or President. They will be asked to support your application.
Name of Club Rep*

First NameLast Name
Club Rep Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Their Role:*

Club CaptainChief InstructorPresident
Medical and Dietary Requirements

Please provide the following information so that we can best support your involvement in the course.
Algal Bloom - The safety of our members is our highest priority. We are guided by expert advice from the State Government, including SA Health, and our Trainers are conducting daily risk assessments at program locations. Our commitment to you is that we will only proceed with activities if it is safe to do so.

If you have any respiratory conditions, such as Asthma, indicate below. Please bring your medication/puffer and communicate your Asthma plan with your Trainers.
Do you have any medical, physical or learning conditions which our facilitators should be aware of to best support your involvement?*

YesNo
If yes, please provide details:
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to the participant*
If the participant is under 18, please provide an email of a parent/guardian who will also receive all relevant communications
Any additional questions or comments?
Terms and Conditions
Declaration and Signature*

Clear
By signing below, you declare that you intend to complete the course and provide continuous support to the SLS club
Should be Empty:

SMAR - Application

Participant Details

SMAR Requirements

Club Support

Medical and Dietary Requirements

Emergency Contact

Terms and Conditions