Please fill out this form completely for Inland Empire pools, we may be in contact if we need more information

Incident Report IE

Incident Report Completed By:*
First Last
Pool Name
Date of Incident*
MM slash DD slash YYYY
Person Involved in Injury or Incident*
First Last
Age*
Phone*
Guest of
First Last
If a minor, Name of Parent or Guardian
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Was Security or 911 called?
Please type up the detailed account of the incident.*
Please attach a picture of side 1 of the incident report.*
Max. file size: 256 MB.
Please attach a picture of side 2 of the incident report.*
Max. file size: 256 MB.
Additional Pages
Max. file size: 256 MB.
Additional Pages
Max. file size: 256 MB.
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You have selected a "Blended Learning" course.

2-410 hours online

1.525.5 hours classroom

IMPORTANT: You will not be able to participate in the classroom portion of the class without a completed certificate from the online portion. Failure to complete the online portion will mean you will need to pay for the course again.

Choose different class

I understand

While this may reduce your time in a classroom it also requires you to do the following prior to attending the in-person portion of your training:

Complete online blended learning course through the American Red Cross
Obtain an online completion certificate and bring it to the in-person skills portion of the class

Please fill out this form completely for Inland Empire pools, we may be in contact if we need more information

Incident Report IE

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