Club Record – Claim Form Club Record – Claim Form Swimmer Name Name of person making the record claim Email Date of Birth Age on Day of Swim Gender Girl Boy Event 50m Freestyle100m Freestyle200m Freestyle400m Freestyle800m Freestyle1500m Freestyle50m Backstroke100m Backstroke200m Backstroke50m Breaststroke100m Breaststroke200m Breaststroke50m Butterfly100m Butterfly200m Butterfly100m IM200m IM400m IM Record Type * 8/Under Age Group Record9 Years – Age Group Record10 Years – Age Group Record11 Years – Age Group Record12 Years – Age Group Record13 Years – Age Group Record14 Years – Age Group Record15 Years – Age Group Record16 Years – Age Group RecordJunior RecordOpen Record Date of Swim / Record Name of meet and venue where record was achieved. Course SC – 25m LC – 50m Time If you are human, leave this field blank. Claim and Submit Record