2022 Christchurch Intermediate Lifeguard School - Head Instructor, Instructor and Mentor Application Form

Before submitting your application for selection as an Head instructor, Instructor or Mentor for this season's Intermediate Lifeguard School, please ensure you have read the selection process and your club are aware of your application.

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* 1. Please indicate what position you wish to apply for

Instructor

Head Instructor

Mentor

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* 2. First Name

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* 3. Last Name

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* 4. SLSNZ Membership Number

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* 5. Club

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* 6. Date of Birth

DD/MM/YYYY

Date

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* 7. Age

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* 8. Gender

Male

Female

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* 9. Email Address

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* 10. Contact number (cell phone)