APPLICATION FORM FOR OFFICIALS/ VOLUNTEERS

2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS

TheLifesaving Society’sQuebec Branch invites all officials and volunteers to submit their applications for the 2015 Canadian Lifeguard Emergency Response Championships. The Championships will take place in Gatineau from May 30 and 31, 2015.

Applications can be submitted by anyone who wishes to be appointed as official or volunteer for these Championships. If you wish to be considered, please complete this form and submit it to Amélie Brun at fore May 1, 2015.

Travel expenses for all officials and volunteers are to be paid for by the individual. Accommodationsare provided for officials and volunteers from out-of-town (100 km and more); however, it is strongly recommended to make arrangements with friends or family, where possible.

Food and refreshments will be provided to officials and volunteers during the Championship events. Officials and volunteers are invited and welcome to attend the awards banquet.

Events will take place at the Gatineau Sports Centre:

Centre sportif de Gatineau, 850de la Gappe blvd., Gatineau, QC J8T 7T7

Phone: 819 503-8500

You will receive a confirmation email along with detailed information regarding the Championships and your participation to this event.

For more information, visit the Lifesaving Society’s website at:

The Lifesaving Society thanks you for your continued support.

APPLICATION FORM FOR OFFICIALS/VOLUNTEERS

2015CANADIAN LIFEGUARD EMERGENCY RESPONSECHAMPIONSHIPS

MAY 30-31, 2015

GATINEAU SPORTS CENTER

First name:Last name:

Lifesaving Society membership number (if applicable):

Home address:

Phone number: Alternate number:

E-mail:

Lifesaving Sport Official certificationstatus:

eXPERIENCE

Please list any particular skill and experience that you may have in pool competitions (i.e.:judge, victim, volunteer, security etc.), and statethe name and date of the competitionwhere this experience was obtained.

Please list in priority order (1, 2, 3 …) which positions you wish to be considered for, 1 being the most preferred. You are not required to complete each and every block.

Position

/ CLERC
Judge
Victims
Scoring
Runner and lock-up

If you wish to be a judge or a victim, please indicate your ability to do so in the following language:

French
English

Please indicate your availability (check all that apply – times are approximate):

Saturday, May 30 / Availability / Sunday, May 31 / Availability
7 am – 12am / 7am – 12 am
12 am – 5 pm / 12 am – 5 pm
5 pm – 8 pm

Travel expenses for all officials/volunteers are to be paid for by the individual.Accommodation is provided for officials and volunteers travelling more than 100 km or more than 1 hour to get to the Championships. If you require accommodations, please indicate below.

The Lifesaving Society will book accommodations. They will be at
Quality Inn & Suites, 111 Bellehumeur street, Gatineau, Quebec, Canada J8T 6K5
Phone:(819) 568-5252
Name: / Preferred Roommate:

Snacks and lunch will be providedonsite during the competition. Please indicate any dietary requirement we should be aware of:

Please return this form to Amélie Brun, at the latest on May 1, 2015,. Applications will continue to be accepted after this date until all positions are filled.

Contact Amélie Brun for any question you might have at , or at 514252-3100 #3690.

The Lifesaving Society sincerely thanks you for your interestand hopes to see you at the 2015 Canadian Lifeguard Emergency Response Championships.

Amélie Brun
Lifesaving Society, Quebec Branch
phone: 514252-3100 #3690
fax: 514254-6232
email: