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Lifeguard Training Inquiry Form
Branch
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Please Select
Brace Family YMCA
Childress Klein YMCA
Dowd YMCA
Harris YMCA
Harris Express YMCA
Johnston YMCA
Keith Family YMCA
Lake Norman YMCA
Lowes YMCA
McCrorey YMCA
Morrison YMCA
Sara's YMCA
Simmons YMCA
Steele Creek YMCA
Stratford Richardson YMCA
Participant first name
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Participant last name
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Phone number
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Email
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Age
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Street address
City
State/Region
ZIP Code
Date of birth
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Gender
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Please Select
Male
Female
Referred by
Any conditions (health or other important information) that the instructor should be aware of?
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Yes
No
Swim Test Prerequisite
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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
By completing this form, I understand, 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 forfeit.
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