Clone of Women in Powercraft Course Registration Form 2025

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 Reb*

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

Club CaptainChief InstructorPresident

Duty of Care and Travel Arrangements

Choose the heading relevant to your age group from the options below
- Duty of Care Agreement
  - Participanct under 18 must be signed in and signed out by a parent or guardian unless alternative written arrangements are approved.
  - Trainers assume duty of care only during Training session times.
  - Duty of care begins at sign-in and ends at sign-out.
  - Parents/guardians must ensure prompt drop-off and collection.
  - Participants must follow all safety instructions.
- I acknowledge and agree to the Duty of Care requirements above.
- Travel to Alternative Locations
  
  If surf conditions are unsuitable or unsafe, training may relocate to a nearby beach or club. Transport may be provided by Trainers or approved support drivers. Particpants in IRB Driver will be required to travel to Goolwa beach during their training and for their final assessment for ideal assessment conditions. Goolwa training will occur once trainers have assessed participants skill levels are ready for more challenging surf conditions
- Travel Permission Acknowledgement
  
  I give permission for my child to travel to alternative training locations with a trainer or approved support driver.I will make alternative travel arrangements for my child to move between locations and will notify the Member Education team of these arrangements via member.ed@surflifesavingsa.com.au
- Parent/Guardian Consent
  
  First Name   Last Name
  
  Date
  
  Signature
- Travel to Alternative Locations
  
  If surf conditions are unsuitable or unsafe, training may relocate to a nearby beach or club.
  
  Particpants in IRB Driver will be required to travel to Goolwa beach during their training and for their final assessment for ideal assessment conditions. Goolwa training will occur once trainers have assessed participants skill levels are ready for more challenging surf conditions.
- Travel Arrangements
  
  I will arrange my own transport to and from the training location.I require transport to be arranged by the trainers

Dietary Requirements
Do you have any dietary requirments?*

YesNo
If yes, please provide details:
Medical Information
Do you have any medical conditions (ie asthma, attention deficit disorder, epilepsy and/or others) or learning challenges which the trainer should be aware of?*

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

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to 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

This program is delivered in line with SLSSA policies and procedures.
Use of image - by indicating below, SLSSA will not use your image inline with the program's terms and conditions

I do not wish my image (photo) taken and used
Declaration and Signature*

Clear
By signing below, you declare that you intend to complete the course and provide continuous support to the SLS club
Internal use
Member selected to participate?

YesSelected as a reserveNoNo, did not meet the criteria
Selection results communicated
Date
Processed by
Should be Empty:

Women in Powercraft Application Form

Club Support

Duty of Care and Travel Arrangements

Dietary Requirements

Medical Information

Emergency Contact

Terms and Conditions

Internal use