Branch Endorsement - Facilitator Bronze Medallion

Branch Endorsement - Facilitator Bronze Medallion

Branches to submit form
SLSQ Branch
Please select your Branch from the dropdown menu
Name of person submitting this form

First NameLast Name
Email of person submitting this form
example@example.com
I confirm the below members hold the correct qualifications/ pre-requisites and have been endorsed by the branch.
Pre-requisites for Facilitator Bronze Medallion
- Be 18 years +
- Hold proficent SLSA Bronze Medallion and PUA20119 Certificate II in Public Safety (Aquatic Rescue)
- Have minimum 2 years patrolling experience
- Hold all WWC requirements (BC, CSA, CYRMs)
- Hold Cert IV TAE 40122 or equivalent
- Be a current Trainer and Assessor Bronze Medallion
- Trained and assessed at least one course in the past two years
Endorsement - Facilitator Bronze Medallion
Branch Executive Member

First NameLast Name
Branch Executive position
Position held
Branch Executive email
example@example.com
Branch Executive meeting date

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