Lifeguard Recertification Form | First to Respond LLC

Course Registration
Lifeguard Recertification Class
The College of New Jersey (TCNJ)
May 17th, 2025 (9:00am to 6:30pm)

First name

Last name

Phone

Street Address

City

State

Postal / Zip code

Birthday of Student

If under 18, please enter the name of the legal parent/guardian:

Emergency Contact

Emergency Contact Phone #:

Please list any allergies the student has. If the student has allergies, please provide details:

Please list any medical conditions the student has. If there are medical conditions, please provide details:

Does the student have any learning accomodations? Please provide details below:

Hip Pack (Adult & Infant Pocket Mask) Please only check ONE of the options below: Required

I will bring my own hip pack (which includes adult and infant pocket mask)

I will purchase a hip pack (which includes adult and infant pocket mask). By checking this I agree to purchase a hip pack on the day of the course for $20 (via cash or Zelle payment).

By clicking here: I have read and agreed to the following statement and terms: As the student, legal parent, or legal guardian, I release and hold harmless First to Respond L.L.C., its owner, employees, and operators from any and all liability, claims, demands, and causes of action whatsoever, that arising out of or related to any damage, loss, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the supervision and control of First to Respond L.L.C., its owners and operators or in route to or from any premises. In consideration of and through my involvement in the Lifeguard Certification/Trainings offered by First to Respond L.L.C. at our training locations or any off-site location services are offered, I (or on behalf of my minor child), acknowledge and agree that I risk bodily injury, including paralysis, dismemberment, and death, as well as loss or damage to property. I knowingly and freely assume all such risk; and I (or on behalf of my minor child) for myself, and on behalf of my heirs, assigns and next of kin hereby release, hold harmless and promise not to sue First to Respond L.L.C. or any off-site training location/affiliate, the instructors of the program, or the persons involved in the facilitation of this program, with respect to all such injury, paralysis, dismemberment, death and/or loss or damage; with the except that which is resultant of gross negligence and/or willful or wanton misconduct. I certify that (or on behalf of my minor child) to be the best of my knowledge, I am in good physical condition and have no disease or injury that would impair my performance or result in my being injured during any program participation. In addition, I (or on behalf of my minor child) do hereby grant permission for duly authorize medical treatment by certified professionals to be administered to me (or my minor child) in the event of injury and that all costs are my responsibility.

By clicking here: 1) I understand that classes may be rescheduled or time-altered, due to weather related emergencies or other unforeseen events. In this event, the course may be rescheduled and students will attend the next available date for the course. 2) I agree that any cancellation, by the participant/student, will result in a $100 administration fee and must be communicated before 7 days of the class via email or phone to receive refund. In addition, no refunds will be allowed within 7 days of the course. 3) I am a certified American Red Cross Lifeguard, or my current American Red Cross Lifeguard Certification will not expire within 30 days of the course and I will show proof of certification at the beginning of course. 4) I understand that failure to meet the criteria of successfully completing the course will result in no refund. 5) I agree to complete the online portion of the course and show proof of completion on the 1st day of course. 6) First to Respond L.L.C. is not responsible for any lost or stolen items. 6) Identification: All students must show identification. For participants under age 17, a school ID, passport or birth certificate are acceptable. 7). Image/Media/Video Consent: The customer or legal guardian agrees to allow First to Respond L.L.C. and their staff to use videos or images in any format, to use at any time, for marketing, media, advertisement or promotion. Additionally, I waive any right to compensation or royaltess that result in the use of this media. If you wish to not be photographed, a written letter or email must be provided 72 hours before the start of the course. 8) Communication: All customers are responsible for reading their emails and responding in a timely manner to First to Respond LLC. 9). The participant is at least 15 years of age. 10). I agree that all of my information above is correct and that either I (if the participant is age 18 or above) or the legal guardian (if the participant is under age 18) have agreed to all terms and conditions.

I certifiy that I current have an American Red Cross Lifeguard Certification (no more than 30 days expired from the start of the class). I also understand that I must bring proof of certification to the in-person portion of the class.

How did you hear about us?

Please type in your full name here (or if under 18, the name of the legal guardian completing this form) to acknowledge the terms above and the Release of Liability, Medical Treatment, Authorization & Consent:

Your registration for the course was successful. Please bon on the lookout for the email with the online portion of the course.

This form no longer accepts submissions.

Course Registration Lifeguard Recertification Class The College of New Jersey (TCNJ) May 17th, 2025 (9:00am to 6:30pm)

Course Registration
Lifeguard Recertification Class
The College of New Jersey (TCNJ)
May 17th, 2025 (9:00am to 6:30pm)