Charlotte Safety Training Online Registration

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Sorry, but the class: "TRI LG 10 FIN" is no longer available.

Welcome to Charlotte Safety Training! Please have an adult 18 or older complete the following form to register. PLEASE READ ! We will review all registrations and then charge the card on file a NON REFUNDABLE fee of $100 for Lifeguard and Lifeguard related ARC courses within 24-48 hours. The fee is required to secure your spot in our courses. All class balances must be paid IN FULL 7 days prior to start of first day of class (we will charge the card on file automatically).

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

PARENT/ GUARDIAN: (MUST BE PARENT IF STUDENT UNDER 18) First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #*

Additional Info

Student Email*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Working for:*

Promo Code (if applicable):

The class you selected on the website is listed below. If you wish to select another class click on the blue button to select another class.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #*

Additional Info

Student Email*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Working for:*

Promo Code (if applicable):

The class you selected on the website is listed below. If you wish to select another class click on the blue button to select another class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #*

Additional Info

Student Email*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Working for:*

Promo Code (if applicable):

The class you selected on the website is listed below. If you wish to select another class click on the blue button to select another class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #*

Additional Info

Student Email*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Working for:*

Promo Code (if applicable):

The class you selected on the website is listed below. If you wish to select another class click on the blue button to select another class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #*

Additional Info

Student Email*

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Working for:*

Promo Code (if applicable):

The class you selected on the website is listed below. If you wish to select another class click on the blue button to select another class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

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Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

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Credit Card

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