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Lifeguarding (r.

12) Registration Form
Course Dates: 10/19/12 – 11/11/12
Name: _________________________________________________________ Street Address: __________________________________________________ Check #_______ $300.00
City of Shelton

Check #_______ $35.00
American Red Cross

City: ______________________________

State: _______ Zip Code: _______ - _____

D.O.B. _____/_____/______ (Minimum age is 15 on or before last class. Bring proof of age to 1st class)

Phone #: (_____) _____ - _______H

(_____) _____ - _______ X _____W

(_____) _____ - _______Cell

E-Mail Address: _______________________________ @ _________________ . _______
____________________________________ _______________________________________ Participant’s Signature Parent’s Signature (if child is under 18 or parent is making payment) (Return completed form WITH check to the Pool Office by 12:00 noon, Wednesday, Oct. 17, 2012.) ----------------------------------------------------------------------------------------------------------------------------------------------------------

Lifeguarding (r.12)
*Prerequisites on Back* This course will include training in the six following disciplines: lifeguard & rescue skills, first aid skills, epi-pen administration, assisting with asthma inhalers, CPR/AED: for the Professional Rescuer skills, and Blood Borne Pathogens: Preventing Disease Transmission. All performance standards & written tests are set-up by the American Red Cross. All skills are tested by a one-time pass or fail practical test and by a written test requiring 80% correct to pass. The participant’s maturity, attitude & behavior are assessed throughout the course as part of the final determination for certification. Any participant’s performance in any component that does not meet the national standards setup by the American Red Cross cannot be certified. Course Fees: TO BE PAID IN FULL at time of registration $300.00 (includes $50.00 non-refundable deposit) Make Check or Checks Payable To: City of Shelton. $35.00 (certificates) Make Check Payable to: American Red Cross ENROLLMENT Min. # of participants = 6 Minimum enrollment must be met before Friday, 10/17/12 @ 12 noon. Max. # of participants = 10 Books are available to download from the American Red Cross Instructors Corner (www.instructorscorner.org). Create an account, login, mouse over the Aquatics tab, click on Lifeguarding. In the box marked Course Materials, click on the participant tab. Click on Access Digital Materials. Click on the Download button next to the Lifeguarding Manual. Follow the directions pertaining to the particular device you will be using. ATTENDANCE is REQUIRED at ALL CLASSES.

Course Days, Dates & Times
10/19, 26 11/02, 09 10/20, 27 11/03, 10 10/21, 28 11/04, 11

Friday Saturda y

6:00 – 9:00 pm

12:00 – 3:00 pm

Sunday

12:00 – 3:00 pm

City of Shelton ~ Parks & Recreation Department ~ Shelton Community Center Pool 41 Church Street, Shelton, CT 06484 ~ (203) 925-8422 ~ (203) 929-3692 FAX www.cityofshelton.org

Bring the following to every class: book, notebook, ballpoint pens, locker for locker use, sweats, bathing suit(s), towels, water, & snacks. PHOTOGRAPHS: Participants may be photographed for the purpose of promotion or advertising in future brochures, in newspapers or in other Shelton Park and Recreation Department media.

City of Shelton ~ Parks & Recreation Department ~ Shelton Community Center Pool 41 Church Street, Shelton, CT 06484 ~ (203) 925-8422 ~ (203) 929-3692 FAX www.cityofshelton.org

Prerequisites: 1.) Swim 300 yards continuously demonstrating breath control & rhythmic breathing. Candidates may swim using the front crawl (freestyle), breaststroke or a combination of both but swimming on the back is not allowed. Swim goggles may be used. 2.) Tread water for 2 minutes using only the legs. Candidates should place the hands under the armpits 3.) Complete a timed event in 1 minute, 40 seconds. Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed. Surface dive, feet-first or head-first, to a depth of 7-10 feet, retrieve a 10-pound object. Return to the surface, swim 20 yards back to the starting point with both hands holding the object & keeping face at or near surface so they are able to get a breath. Candidates should not swim the distance underwater. Exit the water without using a ladder or steps. The prerequisite swimming skills test is designed to test the individual’s strength, endurance, and comfort level in the water. Entry into the Lifeguarding course is strictly limited to those who have successfully completed the swimming skills prerequisite. City of Shelton ~ Parks & Recreation Department ~ Shelton Community Center Pool 41 Church Street, Shelton, CT 06484 ~ (203) 925-8422 ~ (203) 929-3692 FAX www.cityofshelton.org