2020 Bonelli Junior Lifeguard Registration
Filling out this will only hold a spot in the program. First come first serve.

A profile on ActiveNet (our new online system) will have to be created.
1 per family (mark head of household box) add each child on to that account.
Please read more on our website for how to do this process.

Don't forget you still have to turn in on PAPER:
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 1 box
What session would you like to do? *
Select a session: if you want to do both sessions then fill the form out TWICE once for first session and then for second session.
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 phone number *
Type in your home phone number don't forget area code
Your answer
What is your email address *
Your answer
Please RETYPE your email address *
Your answer
What is the age of your child? *
What is the gender of your child? *
Guardian's name *
Your answer
Guardian's Contact number *
Can be a cell phone number
Your answer
Second Guardian's name
Your answer
Second 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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