REQUEST FOR SPORT CLASS EVALUATION
Para-swimming sport class evaluation is provided by Swimming Canada to its members. If the request is for a para-swimmer who is a non-member requiring classification, they should contact Janet Dunn at
jdunn@swimming.ca
.
Swimmer's Last Name
Swimmer's First Name
Swimmer's Swimming Canada Registration Number
Gender
Female
Male
Date of Birth
*Please note Level 2 classifications must be a minimum of 12 years old or have the permission of the Classification Lead and Level 3 classifications must be a minimum of 13 years old or have the permission of the Classification Lead.
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Month
Please select...
January
February
March
April
May
June
July
August
September
October
November
December
Year
Please select...
2015
2014
2013
2012
2011
2010
2009
2008
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2006
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Address
City
Postal Code
Province
Please select...
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Name of Swim Club
Home Phone
Cell Phone
Swimmer or Family Email
Coach Email
What is the nature of your request?
Level 1 (Development)
Level 2 (Provincial)
Level 3 (National)
Please select the impairment that most affects your ability to swim.
Physical Impairment
Visual Impairment/Blind
Intellectual Impairment
Please state your diagnosis/impairment and any associated diagnoses/impairment.
Have you had any operations within the last two years, which may have an impact on your impairment and/or swimming ability?
Yes
No
If yes, please give date(s) of operation(s), a brief overview and the consultant's discharge date.
Name of coach
Name of Parent or Guardian (if swimmer is under 18 years of age)
I can confirm that the above information is correct.
Yes
ClassificationEmail
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