ASA SKILL LEVEL ASSESSMENT DAY

If you wish to apply for a place on the Skill Levels Assessment Day, please complete the form below and club coordinator will send it to: Mrs Lou Collings

Sydney House, 82 Church Road, Christian Malford, Wilts SN15 4BW

Swimmers cheques should be made payable to YOUR CLUB for £10 for each skill. Club coordinators to send forms and cheque for total number of swimmers made payable to ASA SW Region. Please remember to send signed club coordinator & assessor information form.

Burnham Leisure Centre, Berrow Rd, Burnham-on-Sea, TA8 2ET

SATURDAY 19th October 2013 2-6 pm

All Skill Levels – (One Skill Level per swimmer ONLY)

SENIOR SKILL ASSESSOR –Georgie Coombs

Closing Date for applications is Saturday 5thOctober2013

CLUBS MUST SEND APPLICATIONS IN BULK, NO INDIVIDUAL APPLICATIONS FROM SWIMMERS WILL BE ACCEPTED. ALL CLUBS MUST PROVIDE SUFFICIENT, APPROPRIATELY QUALIFIED ASSESSORS TO ACCOMPANY THEIR SWIMMERS.

Also please note: Clubs must send an advanced assessor or assessor if submitting skill 3.4 & 5 for assessment. Failing to supply this level of assessor may preclude your swimmers from being assessed if we do not have sufficient assessorsto cover.

0 – 5 swimmers 1 assessor will be required,

6 -15 swimmers 2 assessors will be required

16-25 swimmers 3 assessors and this will increase in multiples of ten.

There will be approximately 70 applications accepted, 50% of which will be from south west region applicants

****Your Club will be advised in advance of the swimmers who have been allocated a place to take their assessment plus full arrangements for the day.

Important Note: PLEASE NOTE… REMEMBER TO CONSULT CHANGES TO WORDING IN SKILL BOOKLETS AS FROM JAN 2012. Swimmers cannot retake a skill level within one calendar month of a previous failed attempt UNLESS, they failed on retakes and this is recorded in their log books. Swimmersmust produce their log book at each skills assessment or they must be refused entry. Club coaches must sign to confirm swimmers are able to perform the compulsory skills and are ready for the assessment.

First Name[s] : …………………………… Surname : ………………………… [In Block Capitals please]
DOB : ………… ASA Membership Number…………………......
Club : ………………………. Region………
Address :
…………………………………………………………………………………………………………….
Telephone Number[s]: ………………………. Email Address …………………………………..

Present Grades/Skills Held [and Dates Taken] :

Skill Level / Date Taken

SKILL(S) LEVEL TO BE TAKEN : Participant Number : ……………….

[***MUST be completed by applicant] [to be completed by Organiser]

…………………………………………………………………………………………..

I WILL PREPARE ALL SKILL BOOKLETS – PLEASE BRING YOUR OWN LOG BOOKS

Overall Result : PASS / FAIL Signed by Organiser : …………………………...

123456789101112