2018 Bonelli Junior Lifeguard Registration
Filling out this will hold a spot in the program. First come first serve.
Don't forget you still have to turn in:
Application
Consent to Treat
Doctors Release
Code of conduct
Field Trip Slips
Are you New to the program or are you a Returning JG? *
Please check a box
Required
What session would you like to do? *
Check a box if you want to do both sessions then fill the form out twice once for first and then for second
Required
What is your child's last name? *
Please type in the last name
Your answer
What is your child's first name? *
Please type in the first name
Your answer
What is your home address? *
Please type in house number and street
Your answer
City of Residence *
Type in the name of your city
Your answer
Zip Code *
Type in the zip code of your city
Your answer
What is your home phone number *
Type in your home phone number don't forget area code
Your answer
What is your email address *
Your answer
What is the age of your child? *
Your answer
What is the gender of your child? *
Guardian's name *
Your answer
Guardian's Contact number *
Can be a cell phone number
Your answer
Any allergies that your child has that we should be aware of *
Please write the allergies. If none then write NONE.
Your answer
Any current medications? *
Note: If your child uses and Inhaler, Epi Pen or Tylenol and will be using it during program hours. Your physician will need to fill out the Request Medication/ Treatment form.
Your answer
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