NPLQ Title * Name * Gender (please tick one) * Male Female Gender neutral Prefer not to say Date of Birth * Telephone * Email * Emergency Contact Details (Name) * Emergency Contact Details (Telephone) * HOW RLSS UK USE YOUR DATA By completing this form, you agree to the RLSS UK and its two limited companies, RLSS UK Enterprises Ltd. (trading as the RLSS UK Shop) and IQL UK Ltd. processing and storing your personal data for the purpose of fulfilling our contract to provide you with your award or qualification. We promise your personal data will only be used by the RLSS UK, RLSS UK Shop and IQL UK Ltd. We will keep your data safe and will never share it with other organisations without your permission. For full details of how process and store your data please refer to our Privacy Policy that can be found at https://www.rlss.org.uk/privacy-policy Course Prerequisites - all candidates must meet the following criteria before starting the course (please tick to confirm): * Be 16 years of age on date of assessment Jump / dive into deep water Swim 50 metres in no more than 60 seconds Swim 100 metres continuously on front and back In deep water tread water for 30 seconds Surface dive to the floor of the pool Climb out of the pool unaided without using a ladder / steps where the pool design permits Specialist Learning Requirements * YesNo Do you have a disability / medical condition? (please note that a good level of vision and hearing is required for this course YesNo If you have answered yes to either of the above, please provide further details below on how we can assist with your learning: Course Payment Declaration: The cost of this course is £225.00 and must be paid in full with this form to secure your place and by 28/03/22. By completing this form, you are confirming your enrolment onto the RLSS National Pool Lifeguard Qualification course and acceptance of the course information on this form and that you can meet the course prerequisites, that will be assessed on the 1st day of the course (Monday 04/04/22), and if not met, you will be asked to leave the course. I declare that all of the information I have provided on this enrolment form is true and accurate. I understand that if I have failed to declare any specialist learning requirements at this stage, this may impact my ability to successfully pass the assessment and gain the qualification. * Attendee or parent/guardian (if under 18) tick here to agree to the declaration. Date If you are human, leave this field blank. Submit