Withdrawal & Distance Check in Form

1
Swimmer Name* This field is required.
First Name
Last Name
2
Athletes Age* This field is required.
3
Please select the Athletes Club?* This field is required.
Please Select
Please Select
Visiting Club
Barossa
Berri (SA)
Blue Lake Y
Booleroo Centre
Broken Hill Aquatic
Burra
Clare
Clovercrest
Crystal Brook
Dolphins (SA)
Gawler
Gladstone (SA)
Great Southern (SA)
Henley & Grange
Immanuel
Jamestown
Keith
Kent Town
Loxton
Mallee
Marion
Mount Barker (SA)
Mount Gambier
Murray Bridge
Norwood
Onkaparinga
Orroroo
Payneham
Penola
Playford Aquatic
Port Augusta
Port Pirie
Purruna
Quorn
Roxby Downs
Silver City
Southern Performance
STARplex
Tea Tree Gully
The Parks
Unley
Vitor Renmark
West Coast (SA)
Western Aquatic (SA)
Whyalla
4
Contact Email - for confirmation* This field is required.
example@example.com
5
Name of Meet* This field is required.
Please Select
Please Select
2026 Country SC Championships
6
Are you withdrawing from the WHOLE Meet?* This field is required.
Please Select
Please Select
Yes
No
7
Are you withdrawing from a Whole Session?* This field is required.
Please Select
Please Select
No
Yes - Session 1
Yes - Session 2
Yes - Session 3
Yes - Session 4
Yes - Session 5
8
Which event are you CHECKING IN for or WITHDRAWING from?* This field is required.
Please Select
Please Select
50m Freestyle
100m Freestyle
200m Freestyle
400m Freestyle
800m Freestyle
1500m Freestyle
50m Backstroke
100m Backstroke
200m Backstroke
50m Breaststroke
100m Breaststroke
200m Breaststroke
50m Butterfly
100m Butterfly
200m Butterfly
100m Individual Medley
200m Individual Medley
400m Individual Medley
9
Are you swimming or withdrawing from this event?* This field is required.
Please Select
Please Select
Swimming
Withdrawing
10
Are you withdrawing from the heat or final?* This field is required.
Please Select
Please Select
Heat
Final
11
Please confirm in writing that you are withdrawing from this event.* This field is required.
12
Name of Person Completing Form* This field is required.
13
Contact Number for Person Completing Form* This field is required.
first 4 digits of mobile
last 6 digits
14
Signature of person completing form* This field is required.
Should be Empty: