Réclamation sur une décision du juge-arbitre
Réclamation sur une décision du juge-arbitre
Réclamation sur une décision du juge-arbitre
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APPEAL ON REFEREE’S DECISION – PARA SWIMMING<br />
Please complete the form with capital letters<br />
Athlete’s Name: __________________________________________________<br />
Event in which disqualified: _________________________________________<br />
Club or NPC: _____________________________________________________<br />
Coach or Team Leader (printed name): __________________________________<br />
Signature of the above: _______________________________________________<br />
Details of Protest: ________________________________________________________________<br />
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Resolution sort: __________________________________________________________________<br />
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Date and Time Received: _______________________________________________________<br />
Name of the referee receiving the form: ____________________________________________<br />
Signature of the above: __________________________________________________________
Decision of the Jury of Appeal: Accepted: / Denied: <br />
Reason(s): ______________________________________________________________________<br />
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Date and Time: _________________________________________________________________<br />
Name and signature of officials (printed):<br />
____________________________________<br />
TO<br />
____________________________________<br />
TO<br />
____________________________________<br />
TO<br />
Signatures<br />
___________________________________<br />
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RÉCLAMATION SUR UNE DÉCISION DU JUGE-ARBITRE – PARANATATION<br />
Veuillez remplir le formulaire en lettres majuscules<br />
Nom de l’athlète: __________________________________________________<br />
Épreuve de la disqualification: ________________________________________<br />
Club ou CNP: _____________________________________________________<br />
Entraîneur ou gérant d’équipe (lettres moulées): __________________________________<br />
Signature: ________________________________________________________________<br />
Détails de la réclamation: __________________________________________________________<br />
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Résolution: _____________________________________________________________________<br />
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Date et heure reçus: ___________________________________________________________<br />
Nom <strong>du</strong> <strong>juge</strong>-<strong>arbitre</strong> ayant reçu le formulaire: ______________________________________<br />
Signature: ___________________________________________________________________
Décision <strong>du</strong> jury d’appel: Accepté: / Rejeté: <br />
Raison(s): ______________________________________________________________________<br />
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Date et heure: _________________________________________________________________<br />
Nom et signature des officiels (lettres moulées):<br />
____________________________________<br />
OT<br />
____________________________________<br />
OT<br />
____________________________________<br />
OT<br />
Signatures<br />
___________________________________<br />
___________________________________<br />
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