ESS Renewal Form

Swim School Details

Swim School Name *

Swim School Coordinator Name *

Centre Manager *

Street Address *

Postcode *

Postal Address (if different)

Phone *

Email *

Endorsement Requirements

The Swim School requests to be an endorsed provider of the following programs:

Please select all that apply

Infant AquaticsSwim and Survive (Stages 1-12)Bronze Rescue (Stages 13-16)Junior Lifeguard Club

I declare that the Swim School will meet the three (3) eligibility requirements:

Use of program curriculum and certificates (Swim and Survive, Infant Aquatics or JLC) *

Nationally certified instructor qualification as a minimum standard (Swim Teacher or equivalent) *

Instructor/pupil ratios set at or below the maximum ratios as per RLSSA GSPO for each program *

I declare that the Swim School will meet the following Safety Assessment requirements:

Administration Requirements *

Staffing Requirements *

Emergency Procedures *

Instructor: Pupil ratios *

Instruction Guidelines *

First Aid Requirements *

Details of requirements are listed in the Agreement Renewal document

Agreement

Endorsed Swim School Agreement Renewal & Membership Application:

I confirm that I have reviewed all information provided above and agree to submit my Endorsed Swim School Agreement Renewal and Membership application for consideration. *

Digital Certificates (optional)

I'd like to request use of Digital Certificates