2026 NYSE Expression of Interest

2026 NYSE Expression of Interest

Complete this form to express your interest in the 2026 NYSE Lifesaving Development Program on the 23rd to 28th of September. This program is for U14-U17
Participant Information
Full Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Date
Age at Time of Program
Gender
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Residential Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Surf Life Saving Club
Current Age Group / Role
Awards Currently Held:
SLS Membership Number
Shirt Size
Any previous NYSE or similar interstate experience?
Previous NYSE or Similar Interstate Experience Details
Parent / Guardian Information
Full Name of Parent/Guardian 1

First NameMiddle NameLast Name
Relationship to Participant
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Residential Address (if different from participant)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Relationship to Participant
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Medical & Health Information
Are you up to date with immunisations?
Date of last Anti-Tetanus Injection

MonthDayYear
Date
Do you suffer from any of the following?

Other
Please provide full details of any medical conditions selected above
Upload supporting medical documents

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Medicare Number
Private Health Insurance details
Are you insured against accidents for activities other than the SLS Insurance Policy?
If yes, please name the insurance company
Any other relevant medical history?
Has the participant had any recent operations, injuries or illnesses?
If yes, please provide details of recent operations, injuries or illnesses
Do you have any special dietary requirements?
Does the participant have a Medical Management Plan (e.g. Asthma / Anaphylaxis)?
Upload Medical Management Plan

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Confirmation
Upload medical plan or related documents

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Additional Information
Why do you want to attend the 2026 NYSE program? What do you hope to gain from this experience?
Is there anything else the coordination team should know?
Should be Empty:

2026 NYSE Expression of Interest

Participant Information

Parent / Guardian Information

Emergency Contact

Medical & Health Information

Additional Information