WCAB Medical Leave of Absence (LOA) Request

WCAB Medical Leave of Absence Request
Submit this form to request your swimmer to be placed on a Medical Leave of Absence from the WCAB Year-Round Program. This form must be submitted during the first 2 weeks of the absence and substantiated by a note from a Doctor or Physical Therapist.

For your email address below, please enter the email address associated with your WCAB TeamUnify login account.
Parent's Name (primary WCAB TeamUnify Account Holder's Name):*
Parent's Email:*
Medical Leave of Absence Policy

By submitting this form, you are agreeing to WCAB's Medical Leave of Absence Policy outlined below.
- A Medical Leave of Absence must be a minimum of 6 weeks in length, requested during the first 2 weeks of absence and substantiated by a note from a Doctor or Physical Therapist.
- Dues will be waived but must be current at the time of the leave.
- Volunteer commitments are not waived during the leave.
- Written release from a Doctor or Physical Therapist is required before the swimmer can return to the team.
Swimmer's Name:*
Swimmer's Practice Group:*
Medical LOA Start Date:

MonthDayYear
Date
Please upload a copy of the note from a Doctor or Physical Therapist:

Cancelof
Agreement:*

I agree to the WCAB Medical Leave of Absence Policy.
Should be Empty:

WCAB Medical Leave of Absence Request