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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.
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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.
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Upload copy. This can also be sent to the school office following completion of this form.

Criminal Record Check

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Personal Liability Insurance Coverage as a Service Provider  

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Where lifeguarding services are provided by independent contractors, the service provider is responsible for maintaining appropriate liability insurance. Personal Liability Insurance policies are available from the Lifesaving Society.

Experience 

Availability

Emergency Contact

Acknowledgements and Consents

May 20, 2026

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