Lifeguard Certification Interest Form

2. 

4. First Name*

5. Last Name*

7. Are you at least 15 years old?*

   1. Yes

9. Home Phone

10. Cell Phone*

12. Email Address*

14. What JCPRD facility are you interested in working at after gaining certification?*

    1. SMSD Aquatic Center
    2. Shawnee Mission Park Beach
    3. Kill Creek Park Beach
    4. Another facility

    Select all that apply:

15. What JCPRD position are you interested in?

    1. Lifeguard
    2. Head Lifeguard
    3. Swim Lesson Instructor
    4. Front Desk Clerk
    5. Marina Worker
    6. Lifeguard Instructor
    7. Concession Worker

    Select all that apply:

17. Which course do you want to participate in?
    -- Select One --October 2019 CourseDecember 2019 Course February 2020 Course March 2020 Course April 2020 Course Future Course

19. Any additional information you'd like to share, questions or concerns?

21. Thank you!
    Submit your job application now!

    We appreciate you taking the time to complete this form. Lifeguard Courses are open to JCPRD Lifeguard applicants only. If you are ready to apply, click the link above to submit your job application. Either way, we'll be in touch soon!

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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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