Junior Guards Registration Form

Child's Name:*
Birthday:*
age:*
T-Shirt Size:*

Age Group Information: Participants are girls and boys between the ages of 8 and 17. Age groups, used in competitions and practices, are broken down as follows:

AA 16-17 years old

A 14- 15 years old

B 12-13 years old

C 8-11 years old

***New program this year, Starfish Group for ages 6-8***
Parent/Guardian Name:*
Preference Phone #:*
Permanent Address:*
E-mail Address:*
Are you able to be a parent helper?

*** We would need parent helpers on the day of our JG tournament (July 17) with registration, pizza.

Emergency Contact Info:

Emergency Contact Name:*
Relation:*
Cell Phone:
Home Phone:
First year in the program?*
Swimming Ability (brief description)*
If there are any conditions that would limit your child from participating fully in strenuous activity connected with this program/ any food allergies, please explain *

*Session Begins on Monday June 25th through Friday July 27th(Sessions will continue for those competing in the Junior Guard National Championship on August 8th Virginia Beach)

Please Choose from the following groups:


Long Branch Starfish Group: The Cost is $80.00

Description: ONLY FOR AGES 6-8. Practice M/W from 9:30-10:30

Consists of beach awareness and safety, introduction to lifesaving equipment, land base oriented. **INCLUDES LBJG Shirt and Swim Cap


Long Branch Junior Lifeguards: The Cost is $120.00

Description: Juniors of any age will practice M/W from 9:30-10:30.

Consists of beach awareness and safety, sunblock protection, CPR training, practice using lifesaving equipment (boards, torps), running, swimming, getting comfortable with the ocean. *INCLUDES LBJG Shirt and Swim Cap, FEE INCLDUED for LBJG Tournament which is on July 17th

*Please note, if you choose this option and wish to compete in the Regional or National Tournament, you MUST register for USLA (at an additional $10.00 fee)


Long Branch Junior Lifeguards Advanced: The Cost is $175.00

Description: Juniors of any age will practice M/W from 9:30-11:30 and Friday 9:30-11 AM. Consists of beach awareness and safety, sunblock protection, CPR training, more competitive, practice using lifesaving equipment (boards, torps), running, swimming, getting comfortable with the ocean. **INCLUDES LBJG Shirt and Swim Cap, United States Lifesaving Association (USLA) registration, FEE INCLDUED for LBJG


Select Group:*

Junior Guard Tournaments (Tuesdays and Thursdays)

Select Tournaments*

**Please note, these are Pre-Registration fees, if you are registering “Day-Of” there will be a $5.00 fee.

*Please note: You can write 1 check for everything, and Long Branch will write a check to each beach patrol for the tournament*

Waiver/Release

In a consideration of your child being permitted to participate in the Long Branch Junior Lifeguard Program (including tournaments) I hereby waive & release any & all rights & claims for damages that I may have against the Program Coordinator or his/her assistants, the City of Long Branch, their representatives & agents, or anyone connected with the Long Branch Junior Lifeguard Program, for any & all injuries suffered by the above named child while participating in the Long Branch Lifeguard Program.I also understand that injuries may take place during the course of the program due to the nature of the physical activities that take place during the course of the session & tournaments.I understand that the City of Long Branch is not responsible for the insurance payments associated with any injury that may result from participation in the program and tournaments.I understand that the number of participants in the program makes it difficult to monitor all of the actions & behavior of each individual & that the instructors are responsible for the safety of each individual, they can not be held responsible for the actions & behavior of each individual.The parent/guardian must agree to these terms before the child is allowed to participate in the programI certify that to the best of my knowledge, the information I have provided on this form is correct.I agree to, & understand, all of the terms stated on this form. 

Please agree to the above terms and conditions*
Amount due:

Please submit payment to the Recreation office located at 231 Wilbur Ray Ave. in Long Branch. 

All checks can be made out to Long Branch Lifeguards.

Word Verification:

Police Department 
emergencies Dial        9-1-1
non-emergencies       732-222-1000
City Hall                    732-222-7000
        Mon-Fri  8:30am - 4:30pm

Building Department
Stan Midose, Construction Official
344 Broadway, Annex Building, Long Branch, NJ, 07740
732-571-5690

Fire Bureau 
Kevin Hayes Sr., Director
344 Broadway, Annex Building, Long Branch, NJ 07740
732-571-5651

Municipal Court
Terri L. Turner, Court Administrator
279 Broadway, Long Branch, NJ, 07740
732-571-6500

Public Library
Tonya Garcia, Director
328 Broadway, Long Branch, NJ, 07740
732-222-3900

Purchasing
David Spaulding, Purchasing Agent
344 Broadway, Long Branch, NJ 07740
732-571-5656

Tax Assessor
John E. Butow, CTA
344 Broadway, Long Branch, NJ 07740
732-571-5658

Administration
Kevin Hayes Sr., Acting Business Administrator
344 Broadway, Long Branch, NJ, 07740
732-571-5645

City Clerk
Kathy L. Schmelz, RMC City Clerk
344 Broadway, Long Branch, NJ 07740
732-571-5686

Fire Department
Tim Somers, Fire Captain
199 - 205 Union Avenue, Long Branch, NJ 07740
732-222-0076

Personnel
Tara Okros
344 Broadway, Long Branch, NJ, 07740
732-571-5662

Public Works
Fred Migliaccio, Director
636 Joline Avenue, Long Branch, NJ, 07740
732-571-6520

Recreation and Human Services
Carl Jennings, Director
231 Wilbur Ray Avenue, Long Branch, NJ 07740
732-571-6545

Tax Collector
Carla Tomas
344 Broadway, Long Branch, NJ 07740
732-571-5657

Animal Control
Sydney Johnson, Director
344 Broadway, Long Branch, NJ, 07740
732-571-5665

Finance
Michael Martin, Director/CFO
344 Broadway, Long Branch, NJ 07740
732-571-5688

Health
Sydney Johnson, Director
344 Broadway, Long Branch, NJ, 07740
732-571-5665

Planning and Zoning
Michele Bernich, Zoning Officer
344 Broadway, Annex Building, Long Branch, NJ, 07740
732-571-5647

Program/Events
Danna Kawut, Coordinator
344 Broadway, Long Branch, NJ, 07740
732-222-7000 x5447

Senior Affairs
Pat Krosnicki, Director
85 Second Avenue, Long Branch, NJ, 07740
732-571-6542