VICTORIAN MULTI CLASS RECORD APPLICATION FORM
This record application will processed if the meet at which the record is swum is given 'approved' status by Swimming Victoria, any other SwimAus State Swimming Body or National Federation. You are not required to complete this form if the record was swum at a Swimming Victoria Championship Meet. You are required to lodge a completed record application within 14 days of record being swum.
Name of Competitor (as shown in Swim Central)
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Club
*
Name of Coach
*
Name of person completing this application
*
Email
*
example@example.com
Date of Race
*
-
Day
-
Month
Year
Date
Name of Competition
*
Please insert name as described on Competition Flyer, Program or website etc
Host of Competition
*
This will be the organisation conducting the meet eg Swimming Tas, Swimming NZ, Nunawading Swimming Club, D15 Central District etc.
Course Length
*
Short Course - 25 metre (SC)
Long Course - 50 metre (LC)
Name of Pool/Venue
*
Type of Timing Used
*
AOE Automatic (Touchpads)
Semi Automatic (Dolphin System or similar)
Manual (Stopwatches)
Not known
Time Swum
*
eg 1:03.25
Event Type
*
Final
Timed Final
Heat
Was this a split time?
*
No
Yes
Event you achieved the split time
Please include Event Number, Race Description eg, Event 26 200 Freestyle
Classification
*
Please Select
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
S11
S12
S13
S14
S15
S16
S17
S18
S19
Gender
*
Mens/Boys
Womens/Girls
Age Group (select any that apply)
*
Open
18 Years
17 Years
16 Years
15 Years
14 Years
13 Years
12/U Years
Distance
*
50m
100m
150m
200m
400m
800m
1500m
Stroke
*
Backstroke
Breaststroke
Butterfly
Freestyle
Individual Medley
Results File Upload
*
Browse Files
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Choose a file
Meet Mobile Results are not accepted. The following will be considered for record approval: Team Manager (TM) file, full PDF copy of meet results showing; date of meet; meet host; meet name; event nos; event descriptions; event times or a screen shot from 'Live Results', Swim Central, World Aquatics Results or other international Federation results.
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Photo of Swimmer
*
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Please upload a current photograph of swimmer. This image may be used on our social media sites. Note: swimmer should wearing Club tee, hoody or track top and bottoms or an image of the swimmer racing or in the pool. We will not accept images of swimmers standing in bathers.
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Postal Address for Record Certificate
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Submit
Should be Empty: