Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Course prerequisites

Are you a current financial Anglesea SLSC member (2026/27)? Note you are required to ensure that you have renewed your membership prior to the start of the Course.*

Yes

Please upload a copy of your digital member card*

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Max 5MB

I acknowledge that I will be at least 17 years old, at the start of the course*

Yes

Date of birth*

I acknowledge that I am required to attend the entire course (tick box)*

Yes

I acknowledge that I will abide by the Club Member Code of Conduct and if I do not I may be removed from the course (at my or my parents' expense)*

Yes

Please upload a copy of your Bronze Medallion Certificate

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Max 5MB

Please upload a copy of your Marine License. If you don't currently hold one, but intend to obtain prior to the camp, please leave blank.

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Max 5MB

General information

Parent/Guardian full name*

Parent/Guardian contact phone number*

Parent/Guardian contact email*

Name of your school

Please tick if your family has a holiday house in Anglesea

Yes

Please indicate your Silver T-Shirt size?*

Medical information

Please enter your Medicare Number*

Please enter your Medicare Card Reference (single digit next to your name)*

Please tick if you have private hospital insurance

Yes

Do you have Ambulance Cover?*

Yes

Date of last tetanus vaccination*

Please tick if you are asthmatic

Yes

Please tick if you are anaphylactic

Yes

Please provide details of any dietary requirements

Please provide details of any other medical condition that may impact their participation Max 255 characters

Please provide details on any other medication your child is regularly taking Max 255 characters

Club involvement

Please provide details of your involvement in the Club (Patrol, Competition, Nippers, Training, DoorKnock, Rock2Ramp etc)* Max 255 characters

How many hours of volunteer patrols did you complete last season?

Outside of patrols and member training how else do you plan to contribute to the Club in the coming season?* Max 255 characters

Why do you want to gain this qualification in the coming season?* Max 255 characters

Please list up to 2 people you would like to be in a group with Max 255 characters

If you have insufficient room for your responses, please upload your answer in a Word or PDF file

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Max 5MB

Acknowledgement

I acknowledge that I am fit & able to complete the program and have disclosed any injuries/illnesses which may impact on my ability to participate fully. I further acknowledge that should this change in the lead up to the course that I will advise the Clu*

Yes

Select registrations

Silver (IRBD) Camp Fee

$1,050.00 ea

Please note

All prices are inclusive of GST.

Event Waiver

Applications are open to all existing and new ASLSC members. This is an application that will be reviewed by the Member Development team, and depending on numbers and restrictions may not guarentee a position on the course.

I agree to the Event Waiver.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

Details

Basic details

Additional information

Course prerequisites

General information

Medical information

Club involvement

Acknowledgement

Select registrations

Event Waiver