London Swimming Disability Swimming Championships 2012 ...

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London Swimming Disability Swimming Championships 2012 Saturday 6 th October 2012 Hillingdon Sports and Leisure Centre Event Programme All events are swum mixed classification Event Classifications Distance Gender Stroke No 1 S1-S17 100m Girls Freestyle 2 S1-S17 100m Boys Freestyle 3 SB1 - SB3 25m Girls Breaststroke 4 SB1 - SB3 25m Boys Breaststroke 5 SM8 - SM17 100m Girls Butterfly 6 SM8 - SM17 100m Boys Butterfly 7 SM5 – SM17 100m Girls Individual Medley 8 SM5 – SM17 100m Boys Individual Medley 9 S1- S3 25m Girls Backstroke 10 S1- S3 25m Boys Backstroke 11 S4 - S17 50m Girls Butterfly 12 S4 - S17 50m Boys Butterfly 13 SB4 - SB17 50m Girls Breaststroke 14 SB4 - SB17 50m Boys Breaststroke 15 S1 - S3 25m Girls Butterfly 16 S1 - S3 25m Boys Butterfly 17 S1 - S17 50m Girls Backstroke 18 S1 - S17 50m Boys Backstroke 19 S1 – S17 200m Girls Freestyle 20 S1 – S17 200m Boys Freestyle 21 SM1-S4 75m Girls Individual Medley 22 SM1-S4 75m Boys Individual Medley 23 S1 - S3 25m Girls Freestyle 24 S1 - S3 25m Boys Freestyle 25 SB4 - SB17 100m Girls Breaststroke 26 SB4 - SB17 100m Boys Breaststroke 27 S1 - S17 100m Girls Backstroke 28 S1 - S17 100m Boys Backstroke 29 S1 - S17 50m Girls Freestyle 30 S1 - S17 50m Boys Freestyle 4
2012 London Region Disability Swimming Championships Entry Form NAME:____________________________ CLUB:___________________ D.O.B:_____________ Age on day: SEX:___________________ (All competitors should be 9 year or over Saturday 6 th October 2012) IPC/UKSA/UKDS/INAS CLASSIFICATION*(S1–10/11-13/14/15/17):S___ SB___ SM____ B4__ * Please attach copy of FAC Card or relevant classification registration card BRITISH SWIMMING ID TRACKER FORM COMPLETED (if no classification) Yes / No (please delete) REGISTRATION NUMBER: ASA / SASA / WASA ______________________________ PLEASE INDICATE WHICH EVENTS YOU WISH TO ENTER BY SUBMITTING TIMES NEXT TO THE APPROPRIATE EVENTS. Maximum 4 events EVENTS AVAILABLE Classification TIME 25M FREESTYLE S1 – S3 50M FREESTYLE 100M FREESTYLE 200M FREESTYLE 25M BACKSTROKE 50M BACKSTROKE 100M BACKSTROKE 25M BREASTSTROKE 50M BREASTSTROKE 100M BREASTSTROKE 25M BUTTERFLY 50M BUTTERFLY 100M BUTTERFLY 75M I.M. 100M I.M. S1 – S17 S1 - S17 S1 – S17 S1 – S3 S1 - S17 S1 – S17 SB1- SB3 SB4 - SB17 SB4 - SB17 S1- S3 S4 – S17 SM8 – SB17 SM1 – SM4 SM5 – SM17 I CONFIRM I ACCEPT THE PROMOTERS CONDITIONS FOR THE EVENT Signature:............................................................................................... Parent/Guardian To be signed by the parent/guardian of any competitor under the age of 18 years (All competitors under the age of 18 must have parental consent to compete) Signature:........................................................ Competitor Date ............................................. Entry fee £5 (Cheques for £5.00 payable to “London Swimming”) The organisers reserve the right to reject incomplete or late entry forms and those with no payment. Please send completed forms by Monday 17 th September 2012 to: William Collins, 102 Standen Road, Southfields, London, SW18 5TG NEW’ ATHLETES WISHING TO BE CLASSIFIED ENTRY FORMS MUST BE RETURNED BY 27 th August 5
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