2022 GRAL Special Needs Request Form

GRAL Special Needs Request Form
Year *
Club Name *
Swimmer Name *
Swimmer Age *
Swimmer Gender *

Female Male
Please explain the exemption request and rationale. *
Is the Swimmer currently a member in good standing of your team? *

Yes No
Has this swimmer had the same exemption in the past? *

Yes No, this is the first time a request has been made No, the swimmer had a different accommodation
Name of Person filling out this form *

First Name Last Name
Role with club *
E-mail *
Phone Number *

Area Code Phone Number
Anything else you want to tell us?
Should be Empty: