Lifeguard Certification | 2025 – 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 - 7:30pm on Thursday and Friday nights. Saturdays and Sundays will be 9:00am - 5:00pm (unless otherwise instructed by LGI personnel)

Signature *

Clear Signature

Waiver | I accept full responsibility for my use of any apparatus, appliances, facility privileges, or service whatsoever, owned and operated by this club, directors, officers, employees, representatives, and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by myself, my family or others under my supervision or control resulting therefrom. Also, I agree that the information above is accurate and complete. I also understand and acknowledge that photos/videos may be taken for publicity/marketing purposes. I also give my authorization for any photos or video footage of myself or my minor child to be used in this fashion.

Choose which class you need *

How would you like to pay?

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