Clone of SLSSA SMAR Application

SMAR - Application

October 2026
Participant Details
Name

First NameLast Name
Birth Date

DayMonthYear
Gender
E-mail
Mobile Number
Format: 0000 000 000.
SLSSA Club:
Are you:
What year at school are you in this year:
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:
Please confirm that you are available for each session of the SMAR Course:
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.Format: 0000 000 000.
Their Role:
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 dietary requirements, medical, physical or learning conditions which our facilitators should be aware of to best support your involvement?
If yes, please provide details:
Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
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

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