SINGAPORE LIFE SAVING SOCIETY (A Member of the Royal Life Saving Society and International Life Saving Federation)
21 Geylang Bahru Lane, c/o Kallang Basin Swimming Complex, Singapore 339627 Tel: 6299-3660, Email: slss@slss.org.sg, website: www.slss.org.sg
LIFESAVING EXAMINATION BOOKING FORM
For Office Use Only:
(TO PRINT ALL INFORMATION IN CAPITAL LETTERS)
Exam Booking Ref. No: B/
/2016
Please note

Name of Lifesaving Instructor / Teacher:
Organisation:

Address:

Contact Number:


Email:
Exam Award(s):
Final test arrangements, ie, Date/Day/Time/Venue, are strictly subjected to agreement between
the Examiner and Instructor. Instructor is to exercise flexibility to accommodate Examiners’
convenience as their services are voluntary. Instructor must ensure that SLSS is informed of any
change(s) at least 3 days before the exam takes place.
For specific request of preferred test arrangements by the Instructor, an admin fee $100 will be
levied per examination booked, with the exception of LS123 which is bundled. SLSS reserves the
right to review this fee as and when deem fit and appropriate.
Examiner and Instructor are to ensure that no more than one exam booking form, except for
LS123 Awards, is allowed to be administered by the same examiner, at any one time unless with
staggered timing of at least 2 hours.
Please call SLSS ONE WEEK before the test date to confirm the Examiner for this booking.
Thank you.
I undertake to ensure that female candidate, if any, in this exam booking is not
pregnant at the time of this exam booking made.
CARDIO PULMONARY RESUSCITATION (CPR)
I have checked and confirmed that all information and data provided in this booking form is correct. For any
typographical error incurred, I agree to the admin charge of $5.00 per field of amendment of typographical
error, amounting to not exceeding the cost of the exam fee. I understand that the amendment is subjected
to approval by SLSS.
Venue:
Date/Time of Exam:
Name or Signature & Date:
S/No
Name
(print neatly in block letters)
NRIC No.
Date of Birth
Gender
(M/F)
Affiliation
1
2
3
4
For Official Use:
Processed by: Staff Name:
Examiner:
Date Assigned:
Receipt / Inv No.:
Amt Payable:
Specify ‘Yes’ if candidate
is Sport Spore’s Lifeguard
SINGAPORE LIFE SAVING SOCIETY (A Member of the Royal Life Saving Society and International Life Saving Federation)
21 Geylang Bahru Lane, c/o Kallang Basin Swimming Complex, Singapore 339627 Tel: 6299-3660, Email: slss@slss.org.sg, website: www.slss.org.sg
B/
CARDIO PULMONARY RESUSCITATION (CPR)
/
Instructor’s/Teacher’s Name :
Affiliate / Organisation:
CPR/______/______
Venue :
(All sections must be completed in BLOCK CAPITAL LETTERS)
Test Items
Name of Candidates
(Print in BLOCK)
NRIC Number
Theory
Test
C.P.R
Airway
Obstruction
Emergency
Initiative
Test
Results
(Pass/Fail
/Absent)
1
2
3
4
Examiner’s Details:
No. of Passes:
Name:
Date of Exam:
Ref. No.:
Signature:
No. of Failures:
For Office Use Only: No. of Candidates for Booking : (
Booking Payment & Exam Fee Receipt:
Kindly note: All examination forms must be submitted to the SLSS Office
Certificate Printing Processed by:
not later than 3 months from the date of examination. Failure to comply
with the examination rules will render the examination NULL AND VOID.
Date :
Sign:
)
Remarks