Team X-Treme Participant Applications

26/2027 Team X-Treme Program Participant Application

September 2026 till April 2027
APPLICATIONS CLOSE ON FRIDAY 20/SEPT/2026 @ MIDNIGHT
Program Details
- Season-long education and development program
- Training: one weekend per month (sometimes more depending on award)
- Locations: multiple clubs along the Gold Coast
- Includes visits to Heli Base, SOCC, Wave Runner Base, and Thundercat Inflatables
- Educational Awards for Life Saving
Eligibility (Participant)
- Aged 15–17 years old
- Holds a Bronze or SRC award
- Current financial member of a South Coast or Point Danger Branch and affiliated surf club
- Demonstrated eagerness to develop Surf Life Saving skills
FURTHER INFORMATION CAN BE FOUND IN THE CIRCULAR
Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Blue Card
Name on Blue Card
Blue Card Number
Expiry Date
Gender
If Non-binary: Please specify what pronouns you would like used
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Branch
South Coast Clubs
Point Danger Clubs
Shirt Size
Please Note size
Why Would you like to attend this program?
What do you hope to get out of this program other then awards
What awards do you currently hold ?
What Awards would you like to gain
Medical Details
Medicare Card Number
Please include youre Reference number.
Do you Have Private health
Please Provide your Health Insurer
Are you insured against accidents for activities other than the Surf Life Saving Insurance Policy?
Please Provide the company below
Do you have any medical conditions, injuries, or illnesses that may affect your ability to safely undertake the award(s) you wish to attempt?
Please give a brief description of the injuries or illnesses
Do you have any of the following medical concerns:

Other
Please provide further details on medical issue
Do you take any medication?
Please list these medications and when they are required.
Do you require assistance in taking this medication or is it self-managed?
Do you have any Dietary Requirements?
Please provide further details on the Dietary Requirements
Guardian Contact Information

Due to the Nature of the program successful participants will be added to Programs Stack Team App which the guardian listed here will be linked to their profile and also added to the Stack Team Access Group Under our Child safety policy
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship
Emergency Contact 1
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship
MEDICAL DECLARATION: I hereby authorise the obtaining on my behalf of such medical assistance as I may require in the event of accident or illness. I authorise the administering of such medical treatment including the use of anaesthetic, as may be deemed necessary by the Medical Officer attending. I agree to pay the cost of any such medical assistance and any associated costs and expenses and to reimburse Surf Life Saving Queensland Inc. for any such costs and or expenses incurred.
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
If under 18 years, Parent/guardian signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
MEDIA AUTHORISATION: I hereby give consent for Surf Life Saving Queensland (ABN 27 360 485 381) ("SLSQ") to use my name, image and/or quote for any SLSQ internal and/or non-commercial external promotion, education or research prposes and that all proprietary rights including intellectual property rights of any image, photograph or likeness of them will be owned by SLSQ.

I agree that my name, image and/or quotes may be used in any medium including, but not limited to provision of footage to the media and on SLSQ social media sites.

I acknowledge that this permission does not extend to the inclusion of my name, image and/or quote in advertising or via paid endorsement without separate approval for this specific purpose.
Particicpant Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
If under 18 years, Parent/guardian signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
PARTICIPANT DECLARATION: I hereby declare that the information contained in this application is true and correct to the best of my ability at the date of signing it. I acknowledge that by submitting my nomination to participate in this program that I will abide by any requirements of Surf Life Saving Queensland, including all policies, procedures, codes of conduct, etc.

I understand that my responses to all questions will be reviewed as part of the application process.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If under 18 years, Parent/guardian signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

26/2027 Team X-Treme Program Participant Application

APPLICATIONS CLOSE ON FRIDAY 20/SEPT/2026 @ MIDNIGHT

Blue Card

Medical Details

Guardian Contact Information

Emergency Contact 1