Lifeguard Certification | 2026 – Pelican Athletic Club

Name *

First

Last

*Applicants MUST provide proof of DOB by providing a copy of their Driver's License or Birth Certificate. THE CONTACT INFORMATION (BELOW) WILL ALSO BE USED AS THE EMERGENCY CONTACT UNLESS OTHERWISE SPECIFIED

D.O.B *

Student's birthday

Gender *

Parent/Guardian's Name *

First

Last

Are you an employee?

Yes
No

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian's Cell Phone *

Student Cell Phone *

Parent/Guardian's Email *

Student's Email *

Choose which sessions you would like to attend *

***All classes will be 5:00pm - 8:00pm on Wednesday, Thursday and Friday nights. Saturdays and Sundays will be 9:00am - 5:00pm (unless otherwise instructed by LGI personnel)

Are you a member?

All non-members must make an appointment to sign a guest waiver and pay in person. Email: charlotte.boswell@genesishealthclubs.com

Signature *

Clear Signature

I accept full responsibility for my use of any and all apparatus, appliances facility privilege or service whatsoever, owned and operated by this Club at my own risk and shall hold this Club, its shareholders, directors, officers, employees, representatives, and agents harmless from any and all loss, claim, injury, damage or liability sustained or incurred by me resulting therefrom. By completing this form you agree that we may communicate with you by phone, or by using electronic communications such as email and text messaging. Your information will not be sold by Genesis Health Clubs.

Choose which class you need *

How would you like to pay?

A PAC employee will reach out after completing the form to collect payment.