This Connecticut Record Application is for non-CT athletes and relay teams applying for a Connecticut Record.

Today's Date:*

Name of Submitter:*

Email:*

If this is for an individual record, please fill out the athlete's name below. If this is for a relay record, please fill out 4 names later in this application.

Athlete Name:

Club athlete is registered with:

Meet Name:*

First day of meet date:*

Location of Meet:

Race Course:* SCY LCM

Stroke:* Freestyle Backstroke Breaststroke Butterfly IM Free Relay Medley Relay

Distance:* 50 100 200 400 500 800 1000 1500 1650

Swim Type:* Final Prelim Swim-off Split Relay

Time:*

For relay record applications, team members must be listed in order of swimming. Please include age. Example: Jon Smith, 14

Relay Swimmer Name #1:

Relay Swimmer Name #2:

Relay Swimmer Name #3:

Relay Swimmer Name #4:

Please contact ctswim.mccurdy@gmail.com with any questions or comments.

(What is this for?)