Lifeguard Training Inquiry Form

Select Branch *

Participant First Name *

Participant Last Name *

Phone Number *

Email *

Age *

Street Address

City

State

ZIP Code

Date of Birth *

Gender *

Referred By

Any conditions (health or other important information) that the instructor should be aware of?

Yes

Please explain

Swim Test Prerequisite *

OPTION 1: Red Cross Shallow Water Lifeguard I can swim 100 yards without stopping, tread water for 2 minutes, & retrieve a 10lb brick from 5-6 feet of water.

OPTION 2: Red Cross Lifeguard I can swim 300 yards without stopping, tread water for 2 minutes (without the use of my arms), & retrieve a 10lb brick from 7-9 feet of water.

OPTION 3: YMCA Lifeguard I can swim 100 yards without stopping, tread water for 2 minutes, and complete the following strokes: freestyle head up, breaststroke, breaststroke head up, side stroke, and resting stroke, as well as retrieve a ring from approx. 6-7 feet of water tread water for a minute, and complete 100 compressions on a manikin.

OPTION 1: Red Cross Shallow Water Lifeguard

OPTION 2: Red Cross Lifeguard

OPTION 3: YMCA Lifeguard

Attestation *

By completing this form, I understand that, to be eligible to achieve a lifeguard certification I must attend all class dates and times appointed by the instructor. If I fail to complete a class session or skill, I will not obtain the certification, and my payment will be forfeited.