Illinois Injury Petition Must be submitted online and the Doctors Note Faxed or Nest Day Mail.
Deadline  -  In hand 3 Days after last qualifying Meet.

State Meet Petitioning To: Level Level 10 State Level 9 State Level 8 State Level 7 State Level 6 State Level 5 State

Gymnast Name:

USAG#   Birthdate:     

Coach's Name:  Phone #:      Email:

Gym Name: Club#

Address:  City:

State:        Zip:      Gym Phone:

1. One Sanctioned Meet:

Meet:        Date:  Sanction#:    
Vault: Bars:      Beam:      Floor:AA:     

2.Must Fax or Overnight Mail the Physician's written verification of Illness or injury and a date of release for return to activity. To:  State Chair, IL JO Chair, Level Chair
Comments:

I hereby acknowledge all rules and regulations handed down by USA Gymnastics and the State Director. 
 I have read and understand all information pertaining to this petition.  This petition  form contains all the proper names, Birthdates, USAG numbers, and legal levels.
 
By Submitting my name on this form I understand that I ALSO MUST FAX OR OVERNIGHT MAIL THE DOCTOR'S NOTE TO ALL THE REQUIRED PEOPLE BY THE DEADLINE AND am Financially Responsible for all gymnast listed on this form.

Submitted By: Date: