Official Clinic Registration
All Officials Clinic must be registered with Swim Ontario.
Complete all required fields.
Questions regarding this form can be emailed to officials@swimontario.com
Email address *
Clinic Date *
MM
/
DD
/
YYYY
Location (City/Town) *
Your answer
Region *
Clinic Name *
Club(s) Attended *
Enter their codes or full name separated by commas
Your answer
Number of Participants *
Your answer
Course Conductor Name *
Your answer
Course Conductor Level of Certification *
Course Conductor Email Address *
Your answer
Was a mentor/evaluator present
Mentor/ Evaluator Name
Your answer
Mentor / Evaluator Level of Certification
Your answer
Was this clinic being used for advancement purposes? *
Level III, IV or V requirements for certification
Required
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