Provincial Record Application
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- TRACK EVENTS
- THROWING EVENTS
- HORIZONTAL JUMPS EVENTS
- VERTICAL JUMPS EVENTS
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Provincial Record Application Not required if record set at major international competition, National, or Provincial Championships (see below*)
Name of Athlete (preferred name for entry on List of Records: ________________________________________________ Names of members of Relay Team in running order: 1. ___________________________ 2. _________________________ 3. ___________________________4. _________________________ Name of club, school, or province represented when record set: ________________________________________________ Athletics Ontario Club Affiliation, if not as above: _________________________________________________________ Event (Indoor, Outdoor/ 60m, 200m, etc.) __________________________ Age Group: ____________________________ Name of Competition: ________________________________________________________________________________ Facility Name: ___________________________City/Town:___________________________ Date: __________________ Date of Birth:_________________ Birth Certificate previously submitted? _______Citizenship:_____________________ Year/Month/ Day (if not, attach a copy) 
TRACK EVENTS: Official Time: _________________ Wind Reading for events of under 300m: ___________________ Please submit copy of the result or internet link to results. Starter’s name:___________________________________ Signature:________________________________________ Phototimer’s name:________________________________ Signature: ________________________________________ Track Referee’s name:______________________________ Signature: ________________________________________
THROWING EVENTS: Official Distance: ____________ Implement Weight/Manufacture: _________________________ Throws Referee’s name: _____________________________ Signature: ________________________________________ T Signature: _________________________________________ echnical Manager’s Statement: I (name) __________________________ verified the implement before or immediately after the competition and confirm that it met all technical requirements as specified by Athletics Ontario, Athletics Canada and IAAF rules.
HORIZONTAL JUMPS EVENTS: Official distance: _________________ Wind Reading: _______________________ Jumps Referee’s name:______________________________ Signature: ________________________________________
VERTICAL JUMPS EVENTS: Official distance: ______________ Jumps Referee’s name: ______________________________ Signature: ________________________________________
COMBINED EVENTS: Official Score: _______________________ (Please attach results for all events, including wind readings in applicable events.) Combined Events Referee’s name: _____________________ Signature: ________________________________________
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