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Please fill out the following form to submit your record application. Applications for records will only be considered if the submission is received by SwimmingSA within 14 days of the date in which the record was broken.
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1
Is the application for a Long Course or Short Course Record?
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Long Course
Short Course
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Please Select
Long Course
Short Course
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2
Is the application for a State, Multi-Class or Country Record
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SA Multi-Class Record
State Record
State Allcomers Record
State & Allcomers Records
Country Championship Record
Country Record
Country Championships & Country Record
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Please Select
SA Multi-Class Record
State Record
State Allcomers Record
State & Allcomers Records
Country Championship Record
Country Record
Country Championships & Country Record
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3
Select your Classification
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S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
S11
S12
S13
S14
S15
S16
S18
S19
SB1
SB2
SB3
SB4
SB5
SB6
SB7
SB8
SB9
SB11
SB12
SB13
SB14
SB15
SB16
SB18
SB19
SM1
SM2
SM3
SM4
SM5
SM6
SM7
SM8
SM9
SM10
SM11
SM12
SM13
SM14
SM15
SM16
SM18
SM19
Please Select
Please Select
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
S11
S12
S13
S14
S15
S16
S18
S19
SB1
SB2
SB3
SB4
SB5
SB6
SB7
SB8
SB9
SB11
SB12
SB13
SB14
SB15
SB16
SB18
SB19
SM1
SM2
SM3
SM4
SM5
SM6
SM7
SM8
SM9
SM10
SM11
SM12
SM13
SM14
SM15
SM16
SM18
SM19
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4
Select the Swimmers Club?
*
This field is required.
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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
South Australia
Australia
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
South Australia
Australia
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5
Enter the Club Name
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6
Is the record application for an individual swimmer or relay team?
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Individual Swimmer
Relay Team
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Please Select
Individual Swimmer
Relay Team
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7
Swimmers Name
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This field is required.
First Name
Last Name
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8
Age of Swimmer on Day of Meet
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11yrs & U
12yrs
13yrs
14yrs
15yrs
16yrs
17yrs
18yrs
19yrs & O
Open
Please Select
Please Select
11yrs & U
12yrs
13yrs
14yrs
15yrs
16yrs
17yrs
18yrs
19yrs & O
Open
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9
Select the Swimmers Gender
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Female
Male
Mixed (Relays Only)
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Please Select
Female
Male
Mixed (Relays Only)
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10
What Stroke & Distance is the application for?
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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
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
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11
What Relay Event is the application for?
*
This field is required.
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Female 12yrs & U 4x50m Freestyle
Female 14yrs & U 4x50m Freestyle
Female 16yrs & U 4x50m Freestyle
Female 18yrs & U 4x50m Freestyle
Female Open 4x50m Freestyle
Female 14yrs & U 4x100m Freestyle
Female 16yrs & U 4x100m Freestyle
Female 18yrs & U 4x100m Freestyle
Female Open 4x100m Freestyle
Female 16yrs & U 4x200m Freestyle
Female 18yrs & U 4x200m Freestyle
Female Open 4x200m Freestyle
Female 12yrs & U 4x50m Medley
Female 14yrs & U 4x50m Medley
Female 16yrs & U 4x50m Medley
Female 18yrs & U 4x50m Medley
Female Open 4x50m Medley
Female 14yrs & U 4x100m Medley
Female 16yrs & U 4x100m Medley
Female 18yrs & U 4x100m Medley
Female Open 4x100m Medley
Male 12yrs & U 4x50m Freestyle
Male 14yrs & U 4x50m Freestyle
Male 16yrs & U 4x50m Freestyle
Male 18yrs & U 4x50m Freestyle
Male Open 4x50m Freestyle
Male 14yrs & U 4x100m Freestyle
Male 16yrs & U 4x100m Freestyle
Male 18yrs & U 4x100m Freestyle
Male Open 4x100m Freestyle
Male 16yrs & U 4x200m Freestyle
Male 18yrs & U 4x200m Freestyle
Male Open 4x200m Freestyle
Male 12yrs & U 4x50m Medley
Male 14yrs & U 4x50m Medley
Male 16yrs & U 4x50m Medley
Male 18yrs & U 4x50m Medley
Male Open 4x50m Medley
Male 14yrs & U 4x100m Medley
Male 16yrs & U 4x100m Medley
Male 18yrs & U 4x100m Medley
Male Open 4x100m Medley
Mixed 12yrs & U 4x50m Freestyle
Mixed 14yrs & U 4x50m Freestyle
Mixed 16yrs & U 4x50m Freestyle
Mixed 18yrs & U 4x50m Freestyle
Mixed Open 4x50m Freestyle
Mixed 12yrs & U 4x100m Freestyle
Mixed 14yrs & U 4x100m Freestyle
Mixed 16yrs & U 4x100m Freestyle
Mixed 18yrs & U 4x100m Freestyle
Mixed Open 4x100m Freestyle
Mixed 12yrs & U 4x50m Medley
Mixed 14yrs & U 4x50m Medley
Mixed 16yrs & U 4x50m Medley
Mixed 18yrs & U 4x50m Medley
Mixed Open 4x50m Medley
Mixed 12yrs & U 4x100m Medley
Mixed 14yrs & U 4x100m Medley
Mixed 16yrs & U 4x100m Medley
Mixed 18yrs & U 4x100m Medley
Mixed Open 4x100m Medley
Please Select
Please Select
Female 12yrs & U 4x50m Freestyle
Female 14yrs & U 4x50m Freestyle
Female 16yrs & U 4x50m Freestyle
Female 18yrs & U 4x50m Freestyle
Female Open 4x50m Freestyle
Female 14yrs & U 4x100m Freestyle
Female 16yrs & U 4x100m Freestyle
Female 18yrs & U 4x100m Freestyle
Female Open 4x100m Freestyle
Female 16yrs & U 4x200m Freestyle
Female 18yrs & U 4x200m Freestyle
Female Open 4x200m Freestyle
Female 12yrs & U 4x50m Medley
Female 14yrs & U 4x50m Medley
Female 16yrs & U 4x50m Medley
Female 18yrs & U 4x50m Medley
Female Open 4x50m Medley
Female 14yrs & U 4x100m Medley
Female 16yrs & U 4x100m Medley
Female 18yrs & U 4x100m Medley
Female Open 4x100m Medley
Male 12yrs & U 4x50m Freestyle
Male 14yrs & U 4x50m Freestyle
Male 16yrs & U 4x50m Freestyle
Male 18yrs & U 4x50m Freestyle
Male Open 4x50m Freestyle
Male 14yrs & U 4x100m Freestyle
Male 16yrs & U 4x100m Freestyle
Male 18yrs & U 4x100m Freestyle
Male Open 4x100m Freestyle
Male 16yrs & U 4x200m Freestyle
Male 18yrs & U 4x200m Freestyle
Male Open 4x200m Freestyle
Male 12yrs & U 4x50m Medley
Male 14yrs & U 4x50m Medley
Male 16yrs & U 4x50m Medley
Male 18yrs & U 4x50m Medley
Male Open 4x50m Medley
Male 14yrs & U 4x100m Medley
Male 16yrs & U 4x100m Medley
Male 18yrs & U 4x100m Medley
Male Open 4x100m Medley
Mixed 12yrs & U 4x50m Freestyle
Mixed 14yrs & U 4x50m Freestyle
Mixed 16yrs & U 4x50m Freestyle
Mixed 18yrs & U 4x50m Freestyle
Mixed Open 4x50m Freestyle
Mixed 12yrs & U 4x100m Freestyle
Mixed 14yrs & U 4x100m Freestyle
Mixed 16yrs & U 4x100m Freestyle
Mixed 18yrs & U 4x100m Freestyle
Mixed Open 4x100m Freestyle
Mixed 12yrs & U 4x50m Medley
Mixed 14yrs & U 4x50m Medley
Mixed 16yrs & U 4x50m Medley
Mixed 18yrs & U 4x50m Medley
Mixed Open 4x50m Medley
Mixed 12yrs & U 4x100m Medley
Mixed 14yrs & U 4x100m Medley
Mixed 16yrs & U 4x100m Medley
Mixed 18yrs & U 4x100m Medley
Mixed Open 4x100m Medley
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12
Enter swimmers result time
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13
Date of Event where record was swum
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/
Date
Day
Month
Year
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14
Location of Event where Record was swum
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Please Select
South Australia
New South Wales
Northern Territory
Queensland
Tasmania
Victoria
Western Australia
New Zealand
Other International Location
Please Select
Please Select
South Australia
New South Wales
Northern Territory
Queensland
Tasmania
Victoria
Western Australia
New Zealand
Other International Location
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15
Enter Location of Event
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16
Name of Meet Where Record Was Swum
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17
Name of Person Completing Form
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18
Email for confirmation of submission
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example@example.com
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19
Signature of person completing form
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