Intention form

Please fill in below

Firstname *

Lastname *

Email *

Birthday

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Year Year19251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025

Administrative region * Abitibi-TémiscamingueBas-Saint-LaurentCapitale-NationaleCentre-du-QuébecChaudière-AppalachesCôte-NordEstrieGaspésie-Îles-de-la-MadeleineLanaudièreLaurentidesLavalMauricieMontérégieMontréalNord-du-QuébecOutaouaisSaguenay/Lac-Saint-Jean

Selected certification * - Select -Aquatic Emergency CareBoat RescueBoat Rescue For First RespondersBronze CrossBronze MedallionBronze StarCardiopulmonary Resuscitation - ACardiopulmonary Resuscitation - BCardiopulmonary Resuscitation - CCPR - Healthcare ProviderEmergency First AidEmergency First Aid - Early Childhood - 8HEmergency First Aid - Sport and RecreativeEmergency First Aid/AEDFirst Aid Instructor - 16 HoursFirst Aid Instructor - 32 HoursIce Rescue With BoatIce Rescue Without BoatLifesaving InstructorNational Lifeguard - PoolNational Lifeguard - SurfNational Lifeguard - WaterfrontNational Lifeguard - WaterparkPleasure Craft Operator CardPleasure Craft Operator InstructorPool AttendantPrevention Waterfront AreasRecertification - Aquatic Emergency CareRecertification - Bronze CrossRecertification - Bronze MedallionRecertification - First Aid InstructorRecertification - Lifesaving InstructorRecertification - National Lifeguard - PoolRecertification - National Lifeguard - SurfRecertification - National Lifeguard - WaterfrontRecertification - National Lifeguard - WaterparkRecertification - Standard First AidResponder in Waterfront AreasStandard First AidStandard First Aid - Sport and recreativeSwim InstructorSwim Instructor RecertTrainer - Lifesaving InstructorWater Quality

Desired date

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Year Year2024202520262027

I agree to have my contact information transmitted to an organisation that is affiliated to the Lifesaving Society and that offers the course to which I want to register or about which I want more information. *

I accept

Please complete the Captcha *

Enter the characters shown in the image.

• Français