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This form is to be completed by individuals applying to serve as a lifeguard for board-sanctioned programs in accordance with Regulation 1350 – Swimming (https://sd46.bc.ca/wp-content/uploads/1350-Swimming.pdf). It may be relied upon in the event of an emergency. It is the individual’s responsibility to notify the appropriate personnel at the location(s) listed below of any changes to the information provided on this form over the period this form covers.
Note: A single lifeguard service provider application may be used for multiple schools/departments within the district. Please indicate the specific schools or departments where you would like your application to be considered.

Certifications and Qualifications

Please check and provide details for all that apply:

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Upload copy. This can also be sent to the school office following completion of this form.
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Upload copy. This can also be sent to the school office following completion of this form.
Drag & Drop Files, Choose Files to Upload
Upload copy. This can also be sent to the school office following completion of this form.
Drag & Drop Files, Choose Files to Upload
Upload copy. This can also be sent to the school office following completion of this form.
Drag & Drop Files, Choose Files to Upload
Upload copy. This can also be sent to the school office following completion of this form.

Experience 

Availability

Emergency Contact

Acknowledgements and Consents

April 28, 2026

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