Clone of RWC Training Information Form

1
Regional/Branch Office* This field is required.
Sunshine Coast
North Queensland
North Barrier
Wide Bay Capricorn
Sunshine Coast
South Coast
Point Danger
Lifeguards
2
Wide Bay Cap Club Name* This field is required.Select your club
Branch
Moore Park
Bundaberg
Elliott Heads
Hervey Bay
Yeppoon
Emu Park
Tannum
Agnes Water
Operations Support
3
Sunshine Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Noosa Heads
Rainbow Beach
Sunshine Beach
Coolum Beach
Marcoola
Mudjimba
Maroochydore
Alexandra Headland
Mooloolaba
Kawana Waters
Dicky Beach
Metropolitan Caloundra
Bribie Island
Redcliffe Peninsula
Peregian
Operations Support
4
South Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Northcliffe
Broadbeach
Kurrawa
Mermaid Beach A.E.M.E
Nobbys Beach
Miami Beach
North Burleigh
Burleigh Heads Mowbray Park
Point Lookout
Coochiemudlo Island
Southport
Surfers Paradise
Operations Support
5
Point Danger Club Name* This field is required.Please Select your Club
Branch
Brisbane Life Saving
Tugun
Bilinga
North Kirra
Kirra
Coolangatta
Tweed Heads and Coolangatta
Rainbow Bay
Tallebudgera
Pacific Surf
Palm Beach
Currumbin
Operations Support
6
North Queensland Club Name* This field is required.Please Select your Club
Branch
Mission Beach
Port Douglas
Ellis Beach
Cairns
Etty Bay
Operation Support
7
North Barrier Club Name* This field is required.Please Select your Club
Branch
Eimeo
Mackay
Sarina
Forrest Beach
Arcadian
Townsville Picnic Bay
Ayr
Operations Support
8
Lifeguards* This field is required.Please Select your Region
Gold Coast
Sunshine Coast
Wide Bay
North Barrier
North Queensland
9
Select Course
Please Select
Please Select
IRB Crew
Silver Medallion IRB Driver
10
Course Start Date* This field is required.Minimum 14 Days from submission date If your course is not submitted within 14 days of the start date you will be required to provide sufficient reasoning
Date
Day
Month
Year
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Hour
00
15
30
45
Minutes
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Course End Date/Assessment Start Date* This field is required.The course end date should be the same as the assessment date.
Date
Day
Month
Year
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01
02
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Hour
00
15
30
45
Minutes
12
Training Details* This field is required.
13
Primary IRB Facilitator
First, Last Name
Please enter your phone number
Please enter your email address
14
IRB List additional Trainers/Assessors/FacilitatorsAdditional IRB Trainers/Assessors/Facilitators must hold the relevant TAE Qualifications and Surf Award/s
First/Last Name
Trainer/Assessor/Facilitator
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Row 0, Column 0
Row 0, Column 1
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Row 1, Column 0
Row 1, Column 1
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Row 2, Column 0
Row 2, Column 1
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Row 3, Column 0
Row 3, Column 1
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3
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First/Last Name
Row 0, Column 0
Trainer/Assessor/Facilitator
Row 0, Column 1
First/Last Name
Row 1, Column 0
Trainer/Assessor/Facilitator
Row 1, Column 1
First/Last Name
Row 2, Column 0
Trainer/Assessor/Facilitator
Row 2, Column 1
First/Last Name
Row 3, Column 0
Trainer/Assessor/Facilitator
Row 3, Column 1
1 of 4
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List any Probationary IRB Trainers/Assessors/FacilitatorsProbationary IRB Trainers/Assessors/Facilitators must hold the relevant TAE Qualifications
First/Last Name
Probationary Trainer/Assessor/Facilitator
1
Row 0, Column 0
Row 0, Column 1
2
Row 1, Column 0
Row 1, Column 1
3
Row 2, Column 0
Row 2, Column 1
4
Row 3, Column 0
Row 3, Column 1
1
2
3
4
First/Last Name
Row 0, Column 0
Probationary Trainer/Assessor/Facilitator
Row 0, Column 1
First/Last Name
Row 1, Column 0
Probationary Trainer/Assessor/Facilitator
Row 1, Column 1
First/Last Name
Row 2, Column 0
Probationary Trainer/Assessor/Facilitator
Row 2, Column 1
First/Last Name
Row 3, Column 0
Probationary Trainer/Assessor/Facilitator
Row 3, Column 1
1 of 4
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List any Subject Matter ExpertsSME's need to hold an IRB Crew and/or Driver award and have the relevant experience.
First/Last Name
1
Row 0, Column 0
2
Row 1, Column 0
3
Row 2, Column 0
4
Row 3, Column 0
Row 4, Column 0
1
2
3
4
First/Last Name
Row 0, Column 0
First/Last Name
Row 1, Column 0
First/Last Name
Row 2, Column 0
First/Last Name
Row 3, Column 0
First/Last Name
Row 4, Column 0
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Approximate Number of Candidates* This field is required.Participant enrolments close 3 day prior to first session date
18
Do you have CTO approval to set up this course?
YESNO
19
Please contact your CTO before submitting this page.
20
Name of person completing this form* This field is required.
First Name
Last Name
21
Training Details* This field is required.The first session will be the commencement date of the course. The last session date will be the assessment date for the course.
22
Additional commentsIf your course is submitted within 14 days of the start date please provide sufficient reasoning below
Should be Empty: