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 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 IM 200m IM 400m IM Record Type * 8/Under Age Group Record 9 Years – Age Group Record 10 Years – Age Group Record 11 Years – Age Group Record 12 Years – Age Group Record 13 Years – Age Group Record 14 Years – Age Group Record 15 Years – Age Group Record 16 Years – Age Group Record Junior Record Open 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