Course Confirmations

Water Rescue Instructor

Information below is required for all Water Rescue Instructors.

Instructor Candidate Packet

This document contains all information and required reading for Instructor Candidates. Forms must be submitted prior to the academy and may be submitted online, below, or you may print from the packet and email to our office at [email protected].

Instructor Candidate Confirmation Packet (Word Document)

Instructor Candidate Confirmation Packet (pdf)

Required Forms

Instructions

Each candidate must submit the following three forms prior to the start of the Academy.

You can submit online below, or print from the Instructor Candidate Packet and email to our office.

Contact Form

Name
Department/Agency Address
Home Address
MM slash DD slash YYYY

Authorized Provider Agency Agreement

As an Authorized Provider Agency, your department/agency agrees to support the designated representative listed below who has been trained and authorized by Lifesaving Resources as a Water Rescue Instructor.

Instructors must adhere to all Policies and Procedures established by Lifesaving Resources in the conduct of these courses.

To be eligible for re-authorization, they must conduct a minimum of 2 courses within their authorization period, one of which must be a Technician-level course. Each student participating in a Lifesaving Resources' Water Rescue course must receive his/her own Water Rescue Course Guidebook, and upon successful completion of their training, they must be issued a Lifesaving Resources’ Course Completion Certificate. The cost for the required guidebook is currently $19.50 per person.

Failure to adhere to the established Policies and Procedures will invalidate this agreement and your representative's authorization as an Water Rescue Instructor.

Lifesaving Resources agrees to support your designated representative as follows:

1. Provide technical support to Instructors in the conduct of Water Rescue Courses at the Awareness, Operations and/or Technical level.

2. Provide current and up-to-date educational materials (student guidebooks, videotape segments, Instructor Manuals).

3. Provide Course Completion Certificates and Insignia (optional).
Name of Instructor (Your Name)
Mailing Address of Department/Agency

Fire Chief or Training Officer Authorization

Name of Applicant
I hereby consent for the applicant to participate in the Water Rescue Technician Course and verify that he/she is covered by our department (or company) insurance, is not receiving workmen’s compensation at this time, and his/her physical fitness level is appropriate for the course requested. I also am confident that the above named has the aptitude, cognitive learning skills, and physical ability to comprehend and participate in this level of education.
MM slash DD slash YYYY
Prerequisite Reading

Technician Level Courses

Information below is required for all Technician candidates.

Water Rescue Technician Packet

This document contains all information and required reading for Water Rescue Technician course participants. This form must be submitted prior to the start of the course. It may be submitted online, below, or you may print from the packet and email to our office at [email protected], or bring with you to the course.

Technician Candidate Confirmation Packet (Word Document)

Technician Candidate Confirmation Packet (pdf)

Required Form

Instructions

Each participant must submit the following form prior to the start of the course.

You can submit online below, or print from the Participant Packet and email to our office, or bring with you to class.

Fire Chief or Training Officer Authorization

Name of Applicant
I hereby consent for the applicant to participate in the Water Rescue Technician Course and verify that he/she is covered by our department (or company) insurance, is not receiving workmen’s compensation at this time, and his/her physical fitness level is appropriate for the course requested. I also am confident that the above named has the aptitude, cognitive learning skills, and physical ability to comprehend and participate in this level of education.
MM slash DD slash YYYY
Prerequisite Reading