Bronze Medallion Training for Adults

First name *

Surname *

Date of Birth (we need this to match you up with your membership info) *

Email Adress *

Contact Phone Number *

Please rate your swimming ability by choosing how quickly you can swim 400 metres in a swimming pool (not less than 25 metres) More than 10 mins (I would like some coaching to help me improve my swimming ability) 10 minutes of less 9 minutes or less 8 mibutes or less 7 minutes or less *

Please select the category that most clearly defines your surf experience and skills EXCELLENT - Regularly surf and bodysurf, confidident in the surf break and the open water GOOD - Have experience in surfing or body surfing and enjoy getting out in the water SOME - Enjoy going out for a swim in the surf but don't know how to surf or bodysurf TOTAL NEWBIE - Have done little or no swimming in the surf, may be nervous about big wave and open water but want to give it a go *

Please select the option that best describes your surf lifesaving experience I hold a current Surf rescue Certificate and want to upgrade to a Bronze Medallion I have held a Surf Rescue Certificate or Bronze Medallion many years ago Have started Surf Rescue Certificate or Bronze Medallion Training previoulsy but was unable to complete it Have learned some surf lifesaving skills and techniques while being a nipper age manager *

Please select the option that best describes your first aid skills and knowledge I have never done any CPR or First Aid training I have done a CPR or first aid course in the past but it is are not current I hold a current CPR certificate I hold a current Senior/Level II First Aid *

If you hold a current CPR or Senior/Level II First Aid Certificate please give the date you completed the course (approximate is OK, eg: early 2008)

Two way radios are an essential communication tool for the surf lifesaver, please select the option that best describes your skills in the use of two way radios. I have never used two way radios I have used two way radios on several occasions I have used two way radios for work, volunteering or leisure often I have qualifications to use two way radios and use them often for worf or other volunteer activities *

Please outline any other experience or qualifications you may have that relate to the knowledge and skills required to bcome a lifesaver (eg work, paid or volunteer in another emergency service)

Please answer the following questions so that we can plan the most convenient training time and locations

In general I am available for training session on (please tick all appropriate boxes) Monday Evenings Tuesday Evenings Wednesday Evenings Thursday Evenings Saturdays Sundays *

I would prefer to train in the following area (this will help us plan central training locations) Bayside Inner city Eastern Suburbs South Eastern Suburbs Mornington_Peninsula Gippsland Sandy Point *

I am available and would be happy to do some training sessions between Boxing Day and Sunday January 3rd at Sandy Point. Yes No