Women’s State Championships Petition

NGA will accept petitions to a State Championship competition for multiple reasons, including but not limited to, injury, illness, death in the family, religion, or conflicts with school functions. Please complete this form to submit a Petition Request. Petitions should be requested prior to the entry deadline for the respective State Championships (refer to your state calendar) with enough time to be reviewed and possibly approved. This Petition Form is being sent directly to the Women's National Program Director and forwarded to the appropriate State Representative for review and approval. Once the notice of petition is approved, registration can be completed. Allow a minimum of five (5) days for petition review. Please refer to the Rules & Regulations Manual for the most current qualifying score requirements for State Championships.

Name of Competition petitioning to

Date of Competition petitioning to

Competition Entry Deadline Date

Athlete's Name

Reason for Petition
InjuryIllnessFamily DeathSchool ConflictsReligiousOther

If "Other", list below

Athlete's NGA #

Athlete's Birthdate

Athlete's Age

Athlete's Competitive Level
—Please choose an option—L1L2/BLSL3L4LGL5L6LPL7L8LDL9L10

Coach's Name

Coach's Cell

Coach's NGA Professional #

Coach's Email

Club Name

Club Phone Number

Club Address

Club City

Club State
ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Club Zip

Name of Sanctioned Competition

Official Score Results from Sanctioned Competition

VT Score

UB Score

BM Score

FX Score

AA Score

A Licensed Medical Professional must provide written verification of illness or injury and include the release date athlete may return to gymnastics activity.

Please specify the DATE of return to gymnastics activity as determined by the Medical Professional

Upload a Signed Medical Declaration of injury or illness, including the release date