1. Applicant Details


This application form is for the Patrol Captains Training Course on Sunday 19th February 2017, the location is Raglan SLSC
Please ensure you complete the application in full.

Remember the pre-requisites are:

16 years of age and 2 years patrolling experience
Marine VHF Radio Operators Certificate
Current First Aid Level 1
Surf Lifeguard Award (refreshed)
Current member (in the PAM database) of a SLS Club

Unfinished applications will not be considered.

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* 1. Please complete the following personal details:

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* 2. Date of Birth


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* 4. Please complete emergency contact details: