We're sorry, but your browser does not support all required functionality needed to run our app. Please update your browser by clicking here or switch to a different device before continuing. If you're using Internet Explorer, try turning off Compatibility View.
  • Online Portal
  • {{first.Name}} {{first.Name}}
    • {{second.Name}}
Contact Us
Enrol in a course
  • Contact Us
  • Enrol in a course
  • Online Portal
  • {{first.Name}}
    • {{second.Name}}
{{cartCount()}}
  • {{first.Name}}
    • {{second.Name}}
  • {{header.Name}}
  • {{first.Name}}
    • {{second.Name}}
      • {{third.Name}}
  • {{ProgramNav.Name}}
  • {{first.Name}}
    • {{second.Name}}
      • {{third.Name}}
  • {{item.Name}}

SAIL Program Expression of Interest

Royal Life Saving WA is seeking expression of interest for SAIL lessons in Geraldton.  Please fill in the below form if you are interested in being considered for a 1:1 lesson. 

Currently RLSSWA is only offering these lessons at Geraldton, however if you are interested in another location, please enter your preferred location in the form below and we will contact you if/when that location becomes available.
Personal Details
Parent/Guardian Name must have at least 0 and no more than 256 characters.The value of the Parent/Guardian Name field is not valid.
*
Relationship to Student must have at least 0 and no more than 256 characters.The value of the Relationship to Student field is not valid.
*
Street Address must have at least 0 and no more than 512 characters.The value of the Street Address field is not valid.
*
Contact Number must have at least 0 and no more than 256 characters.The value of the Contact Number field is not valid.
*
Enter a valid email address.
*
Student Name must have at least 0 and no more than 256 characters.The value of the Student Name field is not valid.
*
Student Date of Birth (dd/mm/yyyy) must have at least 0 and no more than 256 characters.The value of the Student Date of Birth (dd/mm/yyyy) field is not valid.
*
Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 1 must have at least 0 and no more than 256 characters.The value of the Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 1 field is not valid.
*
Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 2 must have at least 0 and no more than 256 characters.The value of the Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 2 field is not valid.
Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 3 must have at least 0 and no more than 256 characters.The value of the Preferred Lesson Day and Time Frame (e.g. Thursdays, Mornings)- Preference 3 field is not valid.
*
If other, please specify must have at least 0 and no more than 256 characters.The value of the If other, please specify field is not valid.
Application Details

Parents/Carers may consider completing this form which is intended to assist your child and their transition into swimming lessons with Royal Life Saving WA. The information you share will be treated as private and confidential. It will only be used to assist the Instructor who will be taking the lessons.

What is the student's diagnoses?
*
If other, please specify must have at least 0 and no more than 512 characters.The value of the If other, please specify field is not valid.
*
What's the student's experience in the water? must have at least 0 and no more than 512 characters.The value of the What's the student's experience in the water? field is not valid.
*
*
If yes, please specify must have at least 0 and no more than 512 characters.The value of the If yes, please specify field is not valid.
*
If yes, please specify must have at least 0 and no more than 512 characters.The value of the If yes, please specify field is not valid.
*
If yes, please specify must have at least 0 and no more than 512 characters.The value of the If yes, please specify field is not valid.
What goals do you have for the student in this program? must have at least 0 and no more than 512 characters.The value of the What goals do you have for the student in this program? field is not valid.
*
*
If yes, please specify must have at least 0 and no more than 512 characters.The value of the If yes, please specify field is not valid.
What are some of the student’s interests that we can bring into the class? (e.g. trucks, mermaids, dolphins) must have at least 0 and no more than 512 characters.The value of the What are some of the student’s interests that we can bring into the class? (e.g. trucks, mermaids, dolphins) field is not valid.
*
*
If yes, please specify must have at least 0 and no more than 512 characters.The value of the If yes, please specify field is not valid.
Is there any other information not mentioned in the application above that you would like us to know? must have at least 0 and no more than 512 characters.The value of the Is there any other information not mentioned in the application above that you would like us to know? field is not valid.

Connect with us

  • {{link.Title}}

{{first.Name}}
  • {{second.Name}}

{{first.Name}}

{{link.Title}}