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Borough of Ship Bottom 1621 Long Beach Blvd. Ship Bottom NJ 08008 Lifeguard in Training Application Form Ship Bottom Beach Patrol 2015 Due by June 1 2015 Applicant Information Name Age Sex Date of Birth Email address print clearly Summer Phone Summer Address Permanent Address if different from above Phone if different from above Did you participate in LIT last year Adult T-Shirt Size Adult Sweatshirt Size Adult Boardshort Size OR Youth Boardshort Size Medical and Emergency Information Emergency Contact Name Emergency Contact Phone Do you have any medical conditions that we should be aware of If yes please use the back of this application for explanation. You must attach proof of health insurance to your application Sessions and Fees 10-12 year olds will attend on Tuesdays and Thursdays. 13-15 year olds will attend on Mondays Wednesdays and Fridays. The program will be broken up into morning and afternoon sessions for both age groups. Please choose the session in which you would prefer your child to be placed and we will do our best to accommodate you. Placements will be made on a first come first served basis. Thank you Morning 10 30 12 30 Afternoon 2 00 4 00 The Borough of Ship Bottom and the members of the Ship Bottom Beach Patrol are not responsible for LIT members prior to or after hours of the program* The 10-12 year old program fee is 75 and the 13-15 year old program fee is 100. Please make checks payable to the Ship Bottom Beach Patrol and include payment with your application Additional Information LIT applicants must be between the ages of 10-15. The program will run from approximately the end of June through mid-August. Sessions will take place on the 26th Street beach in Ship Bottom* Space is limited and some may be placed on a waiting list. You will be contacted during the first week of June with further information* Any questions regarding LIT can be directed to the Ship Bottom Beach Patrol Headquarters at 609-494-9481 from the middle of June through the middle of September. A completed application includes four 4 items the 2015 Application Form the Hold Harmless Agreement proof of health insurance and payment. Please mail completed applications to the address above Attn Marjorie Duffy LIT Director. Proof of health insurance and the Hold Harmless Agreement MUST be included with your son or daughter s application* Incomplete applications will be denied* Thank you. 13-15 year olds will attend on Mondays Wednesdays and Fridays. The program will be broken up into morning and afternoon sessions for both age groups. Please choose the session in which you would prefer your child to be placed and we will do our best to accommodate you. Please choose the session in which you would prefer your child to be placed and we will do our best to accommodate you. Placements will be made on a first come first served basis. Thank you Morning 10 30 12 30 Afternoon 2 00 4 00 The Borough of Ship Bottom and the members of the Ship Bottom Beach Patrol are not responsible for LIT members prior to or after hours of the program* The 10-12 year old program fee is 75 and the 13-15 year old program fee is 100.

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