NonMember Certification Form

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Please fill out this form if you are wanting to sign up for a certification class at the RWC. With this form, we will create an account in our system for you and will then email you with instructions on how you can sign up online for the program. Please fill out a form for each person needing to have an account made.

First Name *

Last Name *

Date of Birth *

Address (street name and number) *

City *

State *

Zip Code *

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Phone Number *

Please choose the certification you are looking for *

Lifeguarding Full Class

Lifeguard Instructor/LGI Review

Does this account need to be linked with another account? (ex: child, parent) *

Please ask any questions or leave any comments necessary

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