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Team Insurance List and Faxes Received

Insurances as: 4/2/2018 at 10:00AM

Declaration Forms Received as :
4/3/2018 at 10:00AM

Insurance Certificate expiration dates have been updated
Insurances should be faxed to the YMCA Of USA - 312-977-1134

Faxes/emails that have been received will also be posted as we get closer to the entry deadline.  You will be able to view your form to ensure the information has been correctly received

Only one form needs to be faxed/emailed this year
  1) CERTIFICATION, ELIGIBILITY & RELEASE DECLARATION
 

Sample Certificate

Each team that participates in the meet must have a current and correct Certificate of Liability Insurance on file with the YMCA of the USA. Once this form has been submitted to the YMCA of the USA, it should serve to cover all YMCA of the USA sponsored events through the expiration date indicated on the certificate. In other words, a valid certificate that was filed prior to the Short Course Championship that has a long enough expiration date may cover the Masters Championship and the Long Course Championship as well. Exceptions are generally noted in the comments column.

Emails of certificates will be accepted FROM THE INSURANCE BROKER ONLY. Emails may be sent to Robin Lee .
Certificates of Insurance may be faxed to 312-977-1134, HOWEVER, THE ORIGINAL MUST STILL BE SENT to YMCA of the USA, Attn: Insurance Manager, 101 North Wacker Dr., Chicago IL 60606.

Please note: If the insurance column does not have a date,  YMCA of the USA has not yet received a valid insurance certificate. A valid insurance certificate must be received by the YMCA of the USA before the team may compete in a YMCA National meet.


Assoc State Assoc_Name Certificate_Expiration Comments Fax_Received Date_Fax_Received
**5067        Ins must be updated  Check Your faxes  Friday, March 30, 2018 
0012  AL  Birmingham Metropolitan YMCA  11/1/2018       
0104  AL  Greater Montgomery YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
0124  AL  Prattville YMCA  3/31/2019    Check Your faxes  Wednesday, March 28, 2018 
0153  AK  Anchorage Alaska YMCA  10/1/2017  Ins must be updated  Check Your faxes  Monday, March 12, 2018 
0951  CT  Greenwich YMCA  1/1/2019       
0964  CT  Farmington Valley Branch YMCA  12/31/2018    Check Your faxes  Monday, March 26, 2018 
0976  CT  Cheshire YMCA  1/1/2019    Check Your faxes  Wednesday, March 28, 2018 
0983  CT  Laurel East Hartford YMCA  12/31/2018    Check Your faxes  Tuesday, March 20, 2018 
0989  CT  New Canaan Community YMCA  11/7/2018       
1024  CT  Wilton Family YMCA  12/29/2017  Ins must be updated  Check Your faxes  Monday, March 26, 2018 
1033  CT  Regional YMCA of Western Connecticut  7/1/2018    Check Your faxes  Tuesday, March 27, 2018 
1069  CT  Westport Weston CT YMCA  4/1/2019    Check Your faxes  Monday, March 26, 2018 
1089  DE  Brandywine DE YMCA  8/1/2018    Check Your faxes  Tuesday, March 27, 2018 
1105  DE  Western Branch YMCA  8/1/2018    Check Your faxes  Thursday, March 29, 2018 
1126  VA  Fairfax County YMCA in Reston  10/1/2018    Check Your faxes  Monday, March 26, 2018 
1225  FL  Florida First Coast  3/31/2018  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
1245  FL  South Florida YMCA  3/31/2019       
1285  FL  Central Florida Metro YMCA  6/1/2018       
1333  FL  Sarasota Family YMCA  7/1/2018       
1335  FL  South County Family YMCA - FL  4/13/2018    Check Your faxes  Friday, March 30, 2018 
1526  ID  Boise Family YMCA  12/31/2017  Ins must be updated  Check Your faxes  Monday, March 26, 2018 
1575  IL  Champaign County YMCA  3/1/2018  Ins must be updated     
1580  IL  Sage YMCA  10/1/2018    Check Your faxes  Saturday, March 24, 2018 
1739  IL  Decatur Family YMCA  10/1/2014  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
1743  IL  Kishwaukee Family YMCA  9/5/2018    Check Your faxes  Friday, March 23, 2018 
1755  IL  Edwardsville YMCA  2/1/2018  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
1775  IL  Tri City Area IL YMCA  7/1/2018    Check Your faxes  Thursday, March 29, 2018 
1785  IL  Joliet YMCA  7/1/2018    Check Your faxes  Tuesday, March 20, 2018 
1843  IL  BR Ryall NW Dupage YMCA  1/20/2019    Check Your faxes  Wednesday, March 28, 2018 
1879  IL  Springfield IL YMCA  1/1/2019    Check Your faxes  Monday, March 26, 2018 
2029  IN  Cole Center Family YMCA  10/9/2014  Ins must be updated  Check Your faxes  Thursday, March 29, 2018 
2099  IN  Michiana YMCA  7/1/2018    Check Your faxes  Tuesday, April 3, 2018 
2169  IA  Walnut Creek Family YMCA  6/3/2018       
2171  IA  Ankeny Family YMCA  6/3/2018    Check Your faxes  Tuesday, March 27, 2018 
2177  IA  Dubuque Iowa YMCA  12/1/2018    Check Your faxes  Thursday, March 29, 2018 
2337  KY  Ashland Area YMCA  7/15/2018    Check Your faxes  Monday, March 26, 2018 
2353  KY  RC Durr Family YMCA  1/1/2019       
2367  KY  Beaumont Centre Family YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
2512  ME  Waterville Area YMCA  4/1/2019    Check Your faxes  Monday, March 26, 2018 
2513  ME  Old Town Orono YMCA  11/21/2018    Check Your faxes  Wednesday, March 28, 2018 
2517  ME  Down East Family YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
2519  ME  Waldo County YMCA  1/1/2013  Ins must be updated  Check Your faxes  Wednesday, March 28, 2018 
2521  ME  Kennebec Valley YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
2529  ME  Bangor YMCA  12/31/2018    Check Your faxes  Wednesday, March 21, 2018 
2537  ME  Bath Area Family YMCA  10/1/2018    Check Your faxes  Monday, March 26, 2018 
2540  ME  Northern York County YMCA  1/1/2019    Check Your faxes  Wednesday, March 21, 2018 
2581  MD  YMCA in Central Maryland  11/1/2018       
2583  MD  SPY Greater Annapolis YMCA    Ins must be updated  Check Your faxes  Sunday, April 1, 2018 
2615  MD  Cecil County YMCA  12/31/2018    Check Your faxes  Friday, March 23, 2018 
2619  MD  Hagerstown Maryland YMCA  6/13/2018    Check Your faxes  Thursday, March 22, 2018 
2623  MD  Frederick County YMCA  7/1/2018    Check Your faxes  Tuesday, March 27, 2018 
2631  MD  Talbot County YMCA  12/31/2018    Check Your faxes  Tuesday, March 20, 2018 
2793  MA  Malden YMCA  4/1/2016  Ins must be updated  Check Your faxes  Tuesday, March 20, 2018 
2819  MA  New Bedford YMCA  8/1/2018    Check Your faxes  Tuesday, March 27, 2018 
2849  MA  South Shore MA YMCA  1/1/2019       
2853  MA  Burbank Branch YMCA  9/30/2018    Check Your faxes  Friday, March 23, 2018 
2861  MA  North Shore Sterling MA YMCA  12/29/2018    Check Your faxes  Tuesday, March 27, 2018 
2957  MI  Birmingham Family YMCA  8/1/2018    Check Your faxes  Friday, March 30, 2018 
2973  MI  Farmington Family YMCA  8/1/2018    Check Your faxes  Friday, March 30, 2018 
3012  MI  Delta County YMCA  12/31/2018    Check Your faxes  Sunday, April 1, 2018 
3017  MI  Greater Flint YMCA  5/10/2018    Check Your faxes  Thursday, March 29, 2018 
3031  MI  Rapid Area YMCA  8/1/2018    Check Your faxes  Friday, March 30, 2018 
3077  MI  Macomb Family YMCA  8/1/2018    Check Your faxes  Friday, March 30, 2018 
3105  MI  North Oakland Family YMCA  8/1/2018    Check Your faxes  Wednesday, March 28, 2018 
3117  MI  Saginaw YMCA  5/1/2018    Check Your faxes  Friday, March 23, 2018 
3388  MO  Four Rivers Area Branch YMCA  7/1/2018    Check Your faxes  Saturday, March 24, 2018 
3641  NJ  Burlington Camden County YMCA  1/1/2019    Check Your faxes  Wednesday, March 28, 2018 
3685  NJ  Fanwood Scotch Plains YMCA  4/15/2018    Check Your faxes  Monday, March 26, 2018 
3729  NJ  Wyckoff Family YMCA Inc  4/1/2018  Ins must be updated  Check Your faxes  Thursday, March 29, 2018 
3753  NJ  Lakeland Hills Family YMCA  3/31/2019    Check Your faxes  Wednesday, March 28, 2018 
3765  NJ  Hamilton Area NJ YMCA  5/15/2018    Check Your faxes  Sunday, April 1, 2018 
3786  NJ  Metuchen Edison YMCA  3/31/2019    Check Your faxes  Wednesday, March 21, 2018 
3795  NJ  Randolph YMCA  1/1/2019    Check Your faxes  Monday, March 26, 2018 
3799  NJ  The Greater Morristown YMCA  5/1/2018       
3832  NJ  Sussex County Branch YMCA  6/1/2018    Check Your faxes  Tuesday, March 20, 2018 
3863  NJ  Ocean County YMCA  10/1/2018    Check Your faxes  Friday, March 23, 2018 
3883  NJ  Red Bank Branch YMCA  8/1/2018    Check Your faxes  Tuesday, March 27, 2018 
3885  NJ  Ridgewood NJ YMCA  8/1/2018    Check Your faxes  Friday, March 30, 2018 
3915  NJ  Somerset Hills YMCA  4/1/2018  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
3919  NJ  Somerset Valley YMCA  4/1/2018  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
3928  NJ  Summit Branch YMCA  7/1/2018    Check Your faxes  Sunday, April 1, 2018 
3951  NJ  Westfield YMCA  12/31/2018    Check Your faxes  Wednesday, March 28, 2018 
3998  NY  Skaneateles YMCA  3/1/2019    Check Your faxes  Thursday, March 29, 2018 
3999  NY  Auburn YMCA  3/1/2019    Check Your faxes  Tuesday, April 3, 2018 
4063  NY  Greater Canandaigua YMCA  4/1/2019    Check Your faxes  Monday, March 26, 2018 
4073  NY  Clifton Springs Area YMCA  7/1/2018    Check Your faxes  Monday, March 26, 2018 
4115  NY  Glens Falls YMCA  8/31/2018    Check Your faxes  Tuesday, March 27, 2018 
4181  NY  East Hampton RECenter YMCA  7/15/2018    Check Your faxes  Friday, March 30, 2018 
4183  NY  Huntington YMCA  7/15/2018       
4242  NY  Cross Island YMCA  4/1/2019    Check Your faxes  Tuesday, March 27, 2018 
4256  NY  Flushing YMCA  4/1/2019    Check Your faxes  Thursday, March 29, 2018 
4396  NY  Southeast Family Branch YMCA  4/1/2019    Check Your faxes  Friday, March 30, 2018 
4425  NY  Duanesburg YMCA  4/1/2019    Check Your faxes  Sunday, April 1, 2018 
4452  NY  Watertown Family YMCA  1/1/2019    Check Your faxes  Wednesday, March 28, 2018 
4480  NC  Western North Carolina YMCA  10/1/2018    Check Your faxes  Monday, March 26, 2018 
4500  NC  Alamance County Community YMCA  4/1/2018  Ins must be updated  Check Your faxes  Monday, March 26, 2018 
4519  NC  Lowes YMCA  10/31/2018    Check Your faxes  Friday, March 23, 2018 
4546  NC  Goldsboro Family YMCA  11/1/2018    Check Your faxes  Thursday, March 15, 2018 
4549  NC  Greensboro YMCA  8/1/2018    Check Your faxes  Monday, March 26, 2018 
4579  NC  Hickory Foundation YMCA  1/1/2019    Check Your faxes  Monday, March 26, 2018 
4598  NC  Triangle Area YMCA  4/1/2018  Ins must be updated  Check Your faxes  Monday, March 26, 2018 
4600  NC  Twin Rivers NC YMCA  7/1/2017  Ins must be updated     
4614  NC  Rocky Mount Family YMCA  5/1/2018    Check Your faxes  Monday, March 26, 2018 
4622  NC  Wilmington YMCA NC  8/1/2018       
4626  NC  Northwest North Carolina YMCA  7/1/2018    Check Your faxes  Thursday, March 29, 2018 
4772  OH  Meyers Lake YMCA  1/31/2019    Check Your faxes  Monday, March 26, 2018 
4780  OH  Jackson Community YMCA  1/31/2019    Check Your faxes  Tuesday, March 27, 2018 
4785  OH  North Canton Community YMCA  1/31/2019    Check Your faxes  Tuesday, March 27, 2018 
4795  OH  Auglaize Mercer Counties YMCA  4/1/2019    Check Your faxes  Tuesday, March 27, 2018 
4805  OH  Blue Ash YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
4817  OH  ME Lyons Anderson YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
4827  OH  Powel Crosley Jr YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
4891  OH  Geauga Branch YMCA  12/31/2018    Check Your faxes  Friday, March 23, 2018 
4915  OH  Ridgewood Branch OH YMCA  12/31/2018    Check Your faxes  Tuesday, March 27, 2018 
4953  OH  Gahanna YMCA  6/30/2018       
4954  OH  Hilliard YMCA  6/30/2018    Check Your faxes  Thursday, March 22, 2018 
4955  OH  Delaware Community Center YMCA  6/30/2018    Check Your faxes  Tuesday, March 27, 2018 
4974  OH  Liberty Township Powell YMCA  6/30/2018    Check Your faxes  Friday, March 30, 2018 
4991  OH  Jerry L Garver YMCA  6/30/2018       
5004  OH  Kleptz YMCA  8/1/2018       
5018  OH  Coffman Family YMCA  8/1/2018    Check Your faxes  Wednesday, March 28, 2018 
5023  OH  South Family YMCA  8/1/2018    Check Your faxes  Wednesday, March 28, 2018 
5025  OH  Countryside Ralph Stolle YMCA  10/11/2018    Check Your faxes  Tuesday, March 27, 2018 
5075  OH  Lake County East End YMCA  11/1/2018    Check Your faxes  Friday, March 30, 2018 
5083  OH  Lancaster and Fairfield YMCA  9/1/2020    Check Your faxes  Monday, March 26, 2018 
5109  OH  Union County Family YMCA  10/31/2019    Check Your faxes  Friday, March 30, 2018 
5175  OH  Sidney and Shelby County YMCA  12/31/2018    Check Your faxes  Friday, March 30, 2018 
5178  OH  Springfield Family YMCA  8/30/2017  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
5203  OH  Tiffin Community YMCA  12/1/2018    Check Your faxes  Monday, April 2, 2018 
5250  OH  Vermilion Family YMCA  12/31/2018    Check Your faxes  Sunday, April 1, 2018 
5254  OH  Lakota Family YMCA  9/30/2018    Check Your faxes  Tuesday, March 27, 2018 
5275  OH  Youngstown OH YMCA  10/6/2017  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
5280  OH  Wapakoneta Family YMCA  12/22/2018    Check Your faxes  Monday, March 26, 2018 
5478  PA  Central Bucks Family YMCA  7/15/2018    Check Your faxes  Wednesday, March 28, 2018 
5509  PA  Bethlehem YMCA  2/19/2019    Check Your faxes  Thursday, March 29, 2018 
5517  PA  Bradford Family YMCA  2/1/2019    Check Your faxes  Tuesday, March 27, 2018 
5545  PA  Carlisle Family YMCA  7/1/2018    Check Your faxes  Tuesday, March 27, 2018 
5549  PA  Chambersburg Memorial YMCA  10/20/2018    Check Your faxes  Tuesday, March 27, 2018 
5561  PA  Clearfield YMCA  4/15/2018    Check Your faxes  Friday, March 30, 2018 
5566  PA  Jennersville YMCA  9/1/2018    Check Your faxes  Tuesday, March 27, 2018 
5575  PA  Corry YMCA  8/1/2018    Check Your faxes  Wednesday, March 28, 2018 
5602  PA  Franklin YMCA  8/1/2018    Check Your faxes  Monday, March 26, 2018 
5603  PA  Grove City YMCA-PA  8/1/2018    Check Your faxes  Monday, March 26, 2018 
5605  PA  Freeland YMCA  3/19/2018  Ins must be updated     
5637  PA  West Shore YMCA  8/1/2018    Check Your faxes  Thursday, March 29, 2018 
5643  PA  Bloomsburg Area YMCA  2/1/2018  Ins must be updated  Check Your faxes  Wednesday, March 28, 2018 
5645  PA  Hollidaysburg Area YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
5647  PA  Indiana County YMCA  2/4/2019       
5673  PA  Lebanon Valley Family YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
5695  PA  Tri Hampton Family YMCA  7/1/2018    Check Your faxes  Friday, March 30, 2018 
5723  PA  New Castle Community YMCA  2/1/2019    Check Your faxes  Friday, March 23, 2018 
5756  PA  Rocky Run YMCA  1/1/2019    Check Your faxes  Thursday, March 29, 2018 
5773  PA  Lansdowne YMCA  1/1/2018  Ins must be updated  Check Your faxes  Wednesday, March 28, 2018 
5781  PA  Ridley Area YMCA  1/1/2018  Ins must be updated     
5807  PA  Hatboro Area YMCA  1/1/2019    Check Your faxes  Monday, April 2, 2018 
5812  PA  Phoenixville Branch YMCA  1/1/2019       
5839  PA  Sampson Family YMCA  1/1/2019    Check Your faxes  Tuesday, April 3, 2018 
5879  PA  Spencer Family YMCA  1/1/2019    Check Your faxes  Wednesday, March 28, 2018 
5896  PA  Upper Perkiomen Valley YMCA  1/1/2019    Check Your faxes  Monday, March 26, 2018 
5907  PA  Reading and Berks County YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018 
5908  PA  Boyertown Area YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
5928  PA  Schuylkill YMCA  9/1/2018    Check Your faxes  Thursday, March 29, 2018 
5938  PA  State College Family YMCA  1/2/2018  Ins must be updated  Check Your faxes  Thursday, March 29, 2018 
5939  PA  Pocono Family YMCA  3/1/2019    Check Your faxes  Friday, March 30, 2018 
5944  PA  Greater Susquehanna Valley YMCA  4/30/2018    Check Your faxes  Tuesday, March 27, 2018 
5953  PA  Titusville YMCA  3/1/2019    Check Your faxes  Friday, March 30, 2018 
5961  PA  Uniontown Area YMCA  5/25/2018    Check Your faxes  Tuesday, April 3, 2018 
5966  PA  Lionville Community YMCA  9/1/2018    Check Your faxes  Friday, March 30, 2018 
5967  PA  Upper Main Line YMCA  9/1/2018    Check Your faxes  Wednesday, March 28, 2018 
5985  PA  Kennett Area YMCA  9/1/2018    Check Your faxes  Tuesday, April 3, 2018 
5986  PA  West Chester Area YMCA  9/1/2018    Check Your faxes  Sunday, April 1, 2018 
5987  PA  Wilkes Barre Family YMCA  1/1/2018  Ins must be updated     
5992  PA  Eastern Lycoming YMCA   1/1/2019    Check Your faxes  Thursday, March 22, 2018 
5995  PA  York And York County YMCA  1/15/2019    Check Your faxes  Monday, March 26, 2018 
6030  RI  Newport County YMCA  8/1/2018    Check Your faxes  Friday, March 23, 2018 
6046  RI  Bayside Branch YMCA  8/31/2018    Check Your faxes  Thursday, March 22, 2018 
6071  RI  South County RI YMCA  8/31/2018    Check Your faxes  Tuesday, March 20, 2018 
6082  SC  Anderson Area YMCA  1/15/2019    Check Your faxes  Monday, March 26, 2018 
6099  SC  Summerville Family YMCA  7/1/2018    Check Your faxes  Monday, March 26, 2018 
6109  SC  Columbia Northwest Family YMCA  1/1/2019       
6132  SC  Greater Spartanburg YMCA  8/1/2018       
6152  SC  Rock Hill Aquatics Center YMCA  7/15/2018    Check Your faxes  Friday, March 30, 2018 
6450  TX  Benbrook Community Center YMCA  12/31/2018    Check Your faxes  Friday, March 23, 2018 
6663  VT  Greater Burlington YMCA  11/1/2018    Check Your faxes  Friday, March 23, 2018 
6682  VA  Piedmont Family YMCA  12/31/2018       
6721  VA  Lynchburg YMCA  7/10/2018    Check Your faxes  Friday, March 30, 2018 
6731  VA  Martinsville and Henry Co YMCA  12/31/2017  Ins must be updated     
6798  VA  Salem Family YMCA  9/1/2018    Check Your faxes  Monday, March 26, 2018 
6807  VA  Waynesboro Family YMCA  1/26/2018  Ins must be updated  Check Your faxes  Friday, March 30, 2018 
6823  WA  Bremerton YMCA   12/31/2018    Check Your faxes  Tuesday, March 27, 2018 
6855  WA  Skagit Valley Family YMCA  3/1/2018  Ins must be updated  Check Your faxes  Friday, March 23, 2018 
6989  WV  Tri County YMCA Inc  7/1/2018    Check Your faxes  Tuesday, March 27, 2018 
7007  WV  Harrison Area YMCA  8/1/2018    Check Your faxes  Monday, March 26, 2018 
7025  WV  Parkersburg YMCA  12/31/2018    Check Your faxes  Tuesday, March 27, 2018 
7029  WV  Wheeling YMCA  9/15/2018    Check Your faxes  Thursday, March 29, 2018 
7033  WI  Fox Cities YMCA  9/1/2018    Check Your faxes  Friday, March 30, 2018 
7049  WI  Eau Claire Wisconsin YMCA  8/1/2018    Check Your faxes  Wednesday, March 7, 2018 
7061  WI  Green Bay YMCA Metro  1/1/2019    Check Your faxes  Monday, March 26, 2018 
7066  WI  Door County YMCA  1/1/2019    Check Your faxes  Tuesday, March 20, 2018 
7073  WI  La Crosse Area Family YMCA  7/1/2018    Check Your faxes  Wednesday, March 28, 2018 
7101  WI  Manitowoc Two Rivers Area YMCA  12/31/2018    Check Your faxes  Monday, March 26, 2018 
7125  WI  Schroeder YMCA   1/1/2019    Check Your faxes  Friday, March 30, 2018 
7155  WI  Oshkosh Community YMCA  1/1/2019    Check Your faxes  Friday, March 30, 2018 
7169  WI  Stevens Point Area YMCA  1/1/2019    Check Your faxes  Tuesday, March 27, 2018