PERFORMANCE AFFIDAVIT

This form must be completed by all athletes participating in the 2021 U.S. Figure Skating Championship Series presented by Toyota - Junior/Senior Virtual, in addition to their coach and proctor on the day of their performance.

In completing this form, all parties certify the information on this form is accurate and all rules of the Championship Series - Virtual were abided by.

ATHLETE/TEAM INFORMATION

Level *

Event *

Last Name: *

First Name: *

U.S. Figure Skating # *

Email Address: *

Partner Last Name: *

Partner First Name: *

Partner U.S. Figure Skating # *

Partner Email Address *

RECORDING DETAILS

Arena/Rink Name: *

Arena/Rink City, State: *

Recording Date: * +

Recording Time: *

ATHLETE AFFIDAVIT

Athlete Signature: *

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Partner Signature: *

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*

I certify that the recording submitted was recorded on the date and time above. I further attest that the performance was one continuous program and was not edited prior to submission.

*

If I qualify, I agree to all requirements of the U.S. Figure Skating Championships (i.e. bubble environment) including but not limited to, COVID-19 testing, hotel accommodations, meal plan requirements and coach/chaperone policies.

COACH INFORMATION/AFFIDAVIT

Last Name: *

First Name: *

Email Address: *

Cell Phone: *

*

I certify that the recording submitted was recorded on the date and time above. I further attest that the performance was one continuous program and was not edited prior to submission.

Coach Signature: *

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IF YOUR COACH IS NOT PRESENT TO COMPLETE THIS FORM, PROVIDE DETAILS AND PUT AN "X" IN THE SIGNATURE BOX - THEY MUST SEND AN EMAIL TO EVENTS@USFIGURESKATING.ORG VERIFYING YOUR SUBMISSION.

PROCTOR INFORMATION/AFFIDAVIT

Last Name: *

First Name: *

Role *

Proctor Title: *

Email Address: *

Cell Phone: *

*

I certify that the recording submitted was recorded on the date and time above. I further attest that the performance was one continuous program and was not edited prior to submission.

Protcor Signature: *

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