PARA ATHLETE ACCOMODATION/MODIFICATION FORM

ATHLETE NAME*

First and Last Name

USA SWIMMING ID*

Must be 14 alpha-numeric characters

CLUB*

Name or Club Code

COACH*

PARA DIVISION

ATHLETE AGE*

Age as of the first day of the meet

DISABILITY*

DESIRED ACCOMODATION

Please list any support required for the athlete to navigate the facility and/or afford the time, assistance and deck space required to obtain a starting position for each event.

PROPOSED MODIFICATION

Please list any limitation that would prohibit the athlete from completing a specific stroke per the technical rules

ACKNOWLEDGEMENT*

By checking this box, I understand that I/my athlete will remain eligible for any disqualification assessed by the presiding official(s) if the infraction does not relate to the above modifications. Modifications not listed above, which result in an infraction, may be considered at the discretion of the Meet Referee.

REMINDER

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PARA ATHLETE ACCOMODATION and/or MODIFICATION REQUEST FORM

PARA ATHLETE ACCOMODATION and/or MODIFICATION REQUEST FORM