Online Course Booking Form

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Please select the course type

Cardiopulmonary Resuscitation (CPR)
First Aid (includes CPR) (also First Aid in an Education & Care Setting)

Bronze Medallion (includes CPR)
Bronze Medallion Package (includes CPR and First Aid so overall price is cheaper)
Bronze Medallion Re-accreditation (if you have previously done a RLSS Bronze Medallion)

Pool Lifeguard
Pool Lifeguard Package (includes First Aid with Pool Lifeguard so overall price is cheaper)
Pool Lifeguard Update (if you have previously done a RLSS Pool Lifeguard)

Hydrotherapy Rescue Award

Low Voltage Rescue

Pool Plant Operator

Grey Medallion

Compulsory field

Do you have a Discount Voucher (or other special price) ?

No
Yes

Total to be paid $

Your Details:

Title:
First name:
Last name:

Please enter your Date of Birth:


Please enter your email address:


Please enter your phone number:


Please enter your residential address:



   Post Code    

Compulsory field

Have you done a course with us before?

Yes
No
I don't know

Do you have a USI ?

Yes
No
I don't know

Please let us know if you have any special needs, any messages or questions (etc):


Please enter any injuries or impairments that we need to know about.

Confirmation

All courses are subject to minimum student numbers. Your booking will not be finalised until payment has been received and any pre-course requirements met. We will send you a booking confirmation email once the above mentioned requirements have been met.

Payment

Credit Card Authorisation
I authorise the cost indciated below, to be charged to my debit/credit card listed below:

Your credit/debit card will be charged when we process the course enrolment

Card Number:   (eg. 4000 1234 5678 1234)      
CVV Number:    (Click Here to find your CVV)
Card Type: Expiry:
Name on Card:
Amount:
Total to be paid $

Privacy Notice
We respect your privacy. Information collected on this form will be used for the purpose of dealing with your enquiry. This information may be disclosed to relevant staff, officers, members, suppliers, contractors, affiliates and/or training partners. If your feedback involves a person or a response from a person, that person may view the information you have provided in order to respond. Please contact us if you do not agree with our privacy policy as we may not be able to process your feedback. You will be able to access this information by contacting our Privacy Officer.
Note: Certain information from your computer (including your IP address and other identifiers) will be collected when this form is submitted.

Acceptance of Terms and Conditions and Submit form

All courses are subject to our Course Terms and Conditions.
Please click below to accept our course terms and conditions prior to selecting the 'Submit' button.

This form will be processed by our staff during business hours on the next working day. You will recieve an email when processed (please check your junk mail).

I accept the course terms and conditions

I do not accept the course terms and conditions

Form Reference:


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