Your Details

I, the parent named below wish to register my child to attend the Junior Lifeguard Holiday Program:

Junior Lifeguard Program Booking

Your title: Please SelectMrMrsMissMsDrOther

Your name:

Your email:

Telephone Number:

Address:

Suburb:

State:
QLDNSWACTTASSAVICWAOverseasOther

PostCode:

Blue Card Policy

If you are involved in any club activity, other than being with your child, you will be required to obtain a current Blue Card as required in our Child Safety Policy
I have read the above-mentioned policy.

Volunteering

Unfortunately due to the increase in popularity of the program and limited volunteers, we have to cut off enrolment at 35 kids.
However, with every volunteer sign up for the program, the cut-off limit increases due to volunteers involvement.

Volunteers are not required for the full duration of the program. We offer shifts of 1-3 hours per volunteer and is based on your own availability

Do you want to volunteer for the program?

Please select: —Please choose an option—YesNo

Child Enrolments

How many Children are you registering for the program?:
Please select: —Please choose an option—12345

Child 1 details

Name:
Date Of Birth:

Please select shirt size:
Shirt Size: —Please choose an option—Kids 6Kids 7Kids 8Kids 9Kids 10Kids 11Kids 12Kids 13Kids 14SmallMediumLarge

Please confirm that all of the above-mentioned children can
Follow directionsSwim at least 25 metres without assistanceFloat/Tread waterConfident in deep water

Any Medical conditions that we must be aware of?

If your child has none, please type in "NA"

The Program

The program will be held over one week in the school holidays.

Are you a member of Airlie Beach Lifeguard Club: —Please choose an option—YesNo, I prefer to be a non-member.No, however, I would love to sign up! ($100 per Child)I would like to renew my membership ($100 per Child)
Note: If you have participated in this program in 2023, you will be a member of the club. If a returning member please note membership expires on June 30th 2024 and you will need to renew your membership by 1st of July 2024.

Please select the Duration you wish to register for:
Program Date and Length —Please choose an option—Jellyfish Juniors - Wednesday 18 September 2024Rip Tide Runners - Week 1 - 3 daysRip Tide Runners - Wednesday 18 September 2024Rip Tide Runners - Wednesday 18 September 2024 - Thursday 19 September 2024Rip Tide Runners - Wednesday 18 September 2024 - Friday 20 September 2024Rip Tide Runners - Thursday 19 September 2024Rip Tide Runners - Thursday 19 September 2024 - Friday 20 September 2024Rip Tide Runners - Friday 20 September 2024Bronze Medallion (14years+) - Saturday 21 September 2024

Payment

Please note that your child is not enrolled until payment has been processed. We will process the payment manuall after receiving this form (it may take a few days):

Please enter card details for payment:

Card Type: VISA CardMaster Card
Cardholder Name:
Card Number

Card Expiry Date:
Month: Please Select01 - January02 - February03 - March04 - April05 - May06 - June07 - July08 - August09 - September10 - October11 - November12 - December Year: Please Select202120222023202420252026202720282029 CVV: (What is a CVV)

Code of Conduct expected from parents/guardians:

- Adequately prepare your child, for each session (including food, water, sun protection, etc),
- Encourage children to participate in all activities and play by the rules,
- Never ridicule, laugh or yell at a child,
- Applaud all participants (not just your child), good performance and effort (not just winners),
- Advise the Officials if you are not happy with safe practices at the time an incident occurs (not after) so that it can be rectified,
- Respect all decisions of Official, Coaches and Administrators,
- Condemn the use of violence, verbal abuse or vilification,
- Support all policies and practices,
- Encourage children to challenge themselves, and
- Follow correct processes if you have an issue or complaint.

Terms and Conditions

1. Warning
Life Saving Activities can be inherently dangerous. I/we acknowledge that I/we are exposed to certain risks during Life Saving Activities including but not limited to physical exertion, contact with life-saving equipment, body contact and surf, sea & weather conditions. I/we acknowledge that accidents can and often do happen, resulting in me being injured or even killed, or my property being damaged. I/we have voluntarily read and understood this warning and accept and assume the inherent risks in participating in Life Saving Activities. I/we acknowledge that the RLSS and QLL hold no specific insurance (medical, liability or otherwise) for the Life-Saving Activities that I/we and/or my/our Child/Children may undertake.

2. Release & Indemnity:
In consideration of the Club accepting my/our application for membership I/we:
a. Release and will release the Life Saving Organisations from all Claims that I/we may have or may have had but for this release arising from or in connection with my/our membership and/or participation in any Life Saving Activities; and
b. Indemnify and will keep indemnified the Life Saving Organisations to the extent permitted by law in respect of any Claim by any person arising as a result of or in connection with my/our membership and/or participation in any Life Saving activities.

3. Fitness to Participate:
I declare that I/we am/are medically and physically fit and able to participate in any Life Saving Activities. I/we am/are not and must not be a danger to myself or to the health and safety of others. I/we will immediately notify the Club in writing of any change to my/our medical condition, fitness and ability to participate, and will immediately cease Life Saving Activities until cleared by a medical practitioner and acknowledged by the QLL/RLSS.

4. Use of image:
I/we consent to the relevant Life Saving Organisation of which I/we am/are a member, using my/our name, image, likeness and also my/our performance in or of any Life Saving Activity at any time to promote the Objects of the relevant Life Saving Organisation(s), by any form of media. I /we waive any rights I/we might have to or in such use of my/our name, image or likeness by the relevant Life Saving Organisation(s).

Please read the full Terms and conditions attached at the bottom of the page

I have read and agree with the above-mentioned Code of Conduct and Terms and Conditions.

Messages

Please enter any messages or questions that you have:

500

View our disclosure information:
Refund Policy - Privacy Policy