Lifeguard Certification Registration Form

Lifeguard Certification will be offered May 6 – 9, 2024 from 7:00pm to 10pm. Please complete the online form below to register for the class. You will receive a registration reminder by May 2 to attend classes the following week.

Participants must be 15 yrs old to attend and pass the preliminary swim test held on the first night of class. Payment will be at time of online registration to hold your spot for the course. If you do not pass the preliminary swim test on Monday night, our office will request reimbursement paperwork and will refund the course registration fee to you. If you choose not to attend the course, but fail to notify our office before May 1, you will still be charged the full amount. Participants MUST ATTEND all four nights of the class.

Dates: May 6-9, 2024
Times: 7:00pm to 10pm
Cost: $150 Registration Fee + $40 Certification Card
Instructor: Ronnie Mayers

If you have any questions, please contact con-ed@deltastate.edu or by phone at 662-846-4874.

Participant's Name*
First Last
Age*
Gender*
- Male
- Female
Participant's Phone
Participant's Email
Enter Email Confirm Email
Parent/Guardian's Name
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian's Phone*
Parent/Guardian's Email*
Enter Email Confirm Email
Are you taking this class to RENEW your current Lifeguard Certification?
- Yes
- No
DSU Continuing Education reserves the right to cancel, postpone, or combine and substitute qualified instructors when necessary without notification to participants. DSU has the right to alter the class instruction method (face to face or virtual) at any time prior to the start date. Participants will be notified if this happens. No refunds will be given after the registration deadline, day off, or day after the class. If you choose to drop a class and receive refund, you must do so prior to the posted registration deadline on the DSU Continuing Education website.

I agree to the above terms and rules offered for a non-credit class through DSU Continuing Education. I agree to contact DSU Continuing Education for payment of the above class at the completion of submitting this form. I understand that if I do not pay for the class, I will not be registered and a space will not be held for me.
Name
This field is for validation purposes and should be left unchanged.

Lifeguard Certification Registration Form

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