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Team Insurance List and Faxes Received

Insurances as: 4/2/2017 at 7:00AM

Declaration Forms Received as : 4/2/2017 at 9:00PM

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
0012  AL  Birmingham Metropolitan YMCA  11/1/2017    Check Your faxes  Saturday, April 1, 2017 
0104  AL  Greater Montgomery YMCA  1/1/2018       
0124  AL  Prattville YMCA  3/31/2018    Check Your faxes  Monday, March 20, 2017 
0288  CA  Foothills YMCA  5/1/2017       
0951  CT  Greenwich YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
0964  CT  Farmington Valley Branch YMCA  12/31/2017    Check Your faxes  Monday, March 27, 2017 
0976  CT  Cheshire YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
0983  CT  Laurel East Hartford YMCA  12/31/2017    Check Your faxes  Tuesday, March 28, 2017 
0989  CT  New Canaan Community YMCA  11/7/2017       
0996  CT  Soundview Family YMCA  5/1/2017       
1024  CT  Wilton Family YMCA  12/29/2017    Check Your faxes  Tuesday, March 21, 2017 
1065  CT  Greater Waterbury YMCA  10/1/2017       
1069  CT  Westport Weston CT YMCA  4/1/2018    Check Your faxes  Friday, March 31, 2017 
1082  DE  Sussex Family Branch YMCA  8/1/2017    Check Your faxes  Friday, March 24, 2017 
1089  DE  Brandywine DE YMCA  8/1/2017    Check Your faxes  Saturday, March 25, 2017 
1105  DE  Western Branch YMCA  8/1/2017    Check Your faxes  Monday, March 27, 2017 
1245  FL  South Florida YMCA  3/31/2018       
1285  FL  Central Florida Metro YMCA  6/1/2017       
1333  FL  Sarasota Family YMCA  7/1/2017    Check Your faxes  Thursday, March 30, 2017 
1382  GA  Georgia's Piedmont YMCA  1/1/2018    Check Your faxes  Wednesday, March 29, 2017 
1526  ID  Boise Family YMCA  12/31/2017    Check Your faxes  Monday, March 27, 2017 
1575  IL  Champaign County YMCA  3/1/2018    Check Your faxes  Monday, March 27, 2017 
1580  IL  Sage YMCA  10/1/2017    Check Your faxes  Monday, March 27, 2017 
1627  IL  Leaning Tower YMCA  10/1/2017       
1743  IL  Kishwaukee Family YMCA  9/5/2017    Check Your faxes  Saturday, March 25, 2017 
1751  IL  Southwest Illinois YMCA  7/1/2017    Check Your faxes  Tuesday, March 28, 2017 
1755  IL  Edwardsville YMCA  2/1/2018    Check Your faxes  Friday, March 31, 2017 
1775  IL  Tri City Area IL YMCA  7/1/2017    Check Your faxes  Thursday, March 30, 2017 
1779  IL  Sherwood Eddy Memorial YMCA  8/5/2017    Check Your faxes  Thursday, March 23, 2017 
1785  IL  Joliet YMCA  4/1/2018    Check Your faxes  Friday, March 24, 2017 
1843  IL  BR Ryall NW Dupage YMCA  1/20/2018    Check Your faxes  Saturday, March 25, 2017 
1857  IL  Illinois Valley YMCA  6/1/2017    Check Your faxes  Wednesday, March 29, 2017 
1871  IL  Rock River Valley YMCA  9/1/2017    Check Your faxes  Monday, March 27, 2017 
1879  IL  Springfield IL YMCA  1/1/2018       
1951  IN  Central Branch YMCA  8/1/2017       
2045  IN  Steuben County YMCA  2/1/2019    Check Your faxes  Monday, March 27, 2017 
2169  IA  Walnut Creek Family YMCA  9/1/2017    Check Your faxes  Monday, March 27, 2017 
2337  KY  Ashland Area YMCA  7/15/2017    Check Your faxes  Thursday, March 30, 2017 
2430  KY  Wilderness Trace Family YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
2512  ME  Waterville Area YMCA  4/1/2018    Check Your faxes  Monday, March 27, 2017 
2513  ME  Old Town Orono YMCA  11/21/2017    Check Your faxes  Wednesday, March 29, 2017 
2517  ME  Down East Family YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
2521  ME  Kennebec Valley YMCA  1/1/2018    Check Your faxes  Thursday, March 30, 2017 
2525  ME  Auburn Lewiston Twin Cities YMCA  6/13/2017    Check Your faxes  Tuesday, March 28, 2017 
2533  ME  Mount Desert Island YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
2537  ME  Bath Area Family YMCA  10/1/2017    Check Your faxes  Thursday, March 23, 2017 
2540  ME  Northern York County YMCA  1/1/2018    Check Your faxes  Wednesday, March 22, 2017 
2581  MD  YMCA in Central Maryland  11/1/2017       
2583  MD  SPY Greater Annapolis YMCA    Ins must be updated     
2601  MD  Catonsville YMCA  11/1/2017       
2619  MD  Hagerstown Maryland YMCA  6/13/2017    Check Your faxes  Monday, March 20, 2017 
2623  MD  Frederick County YMCA  7/1/2017       
2626  MD  Richard A Henson Family YMCA  12/31/2017    Check Your faxes  Thursday, March 30, 2017 
2631  MD  Talbot County YMCA  12/31/2017    Check Your faxes  Monday, March 27, 2017 
2769  MA  Greater Holyoke YMCA  10/15/2017    Check Your faxes  Thursday, March 30, 2017 
2819  MA  New Bedford YMCA  8/1/2017    Check Your faxes  Wednesday, March 29, 2017 
2849  MA  South Shore MA YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
2853  MA  Burbank Branch YMCA  9/30/2017    Check Your faxes  Wednesday, March 29, 2017 
2861  MA  North Shore Sterling MA YMCA  12/29/2017    Check Your faxes  Wednesday, March 29, 2017 
2901  MA  Greater Westfield YMCA  9/16/2016  Ins must be updated  Check Your faxes  Friday, March 31, 2017 
2957  MI  Birmingham Family YMCA  8/1/2017    Check Your faxes  Wednesday, March 29, 2017 
2973  MI  Farmington Family YMCA  8/1/2017    Check Your faxes  Tuesday, March 28, 2017 
3012  MI  Delta County YMCA  12/31/2017    Check Your faxes  Wednesday, March 29, 2017 
3017  MI  Greater Flint YMCA  5/10/2017    Check Your faxes  Thursday, March 30, 2017 
3031  MI  Rapid Area YMCA  8/1/2017    Check Your faxes  Wednesday, March 29, 2017 
3037  MI  Grand Traverse Bay YMCA  7/1/2017    Check Your faxes  Friday, March 31, 2017 
3050  MI  Marquette County YMCA  4/8/2017    Check Your faxes  Tuesday, March 28, 2017 
3077  MI  Macomb Family YMCA  8/1/2017    Check Your faxes  Thursday, March 30, 2017 
3105  MI  North Oakland Family YMCA  8/1/2017    Check Your faxes  Sunday, April 2, 2017 
3117  MI  Saginaw YMCA  5/1/2017    Check Your faxes  Wednesday, March 22, 2017 
3406  MO  O'Fallon Family YMCA  7/1/2017    Check Your faxes  Thursday, March 30, 2017 
3477  NE  Grand Island Nebraska YMCA  1/1/2018    Check Your faxes  Tuesday, March 28, 2017 
3641  NJ  Burlington Camden County YMCA  7/1/2017    Check Your faxes  Thursday, March 23, 2017 
3685  NJ  Fanwood Scotch Plains YMCA  4/15/2017    Check Your faxes  Wednesday, March 29, 2017 
3729  NJ  Wyckoff Family YMCA Inc  4/1/2018    Check Your faxes  Monday, March 27, 2017 
3753  NJ  Lakeland Hills Family YMCA  3/31/2018    Check Your faxes  Wednesday, March 29, 2017 
3765  NJ  Hamilton Area NJ YMCA  5/15/2017    Check Your faxes  Monday, March 27, 2017 
3786  NJ  Metuchen Edison YMCA  3/31/2018    Check Your faxes  Monday, March 27, 2017 
3795  NJ  Randolph YMCA  1/1/2018    Check Your faxes  Friday, March 24, 2017 
3799  NJ  The Greater Morristown YMCA  5/1/2017    Check Your faxes  Tuesday, March 28, 2017 
3832  NJ  Sussex County Branch YMCA  6/1/2017    Check Your faxes  Thursday, March 23, 2017 
3863  NJ  Ocean County YMCA  10/1/2016  Ins must be updated  Check Your faxes  Tuesday, March 28, 2017 
3883  NJ  Red Bank Branch  8/1/2017    Check Your faxes  Friday, March 24, 2017 
3885  NJ  Ridgewood NJ YMCA  8/1/2017    Check Your faxes  Tuesday, March 28, 2017 
3915  NJ  Somerset Hills YMCA  4/1/2018       
3919  NJ  Somerset Valley YMCA  4/1/2018    Check Your faxes  Thursday, March 30, 2017 
3928  NJ  Summit Branch YMCA  7/1/2017    Check Your faxes  Friday, March 24, 2017 
3951  NJ  Westfield YMCA  12/31/2017       
3999  NY  Auburn YMCA  3/1/2018    Check Your faxes  Wednesday, March 29, 2017 
4003  NY  Genesee Area Family YMCA  8/25/2017    Check Your faxes  Monday, March 27, 2017 
4077  NY  Cortland County Family YMCA  8/1/2017    Check Your faxes  Tuesday, March 28, 2017 
4115  NY  Glens Falls YMCA  8/31/2017    Check Your faxes  Monday, March 27, 2017 
4181  NY  East Hampton RECenter YMCA  7/15/2017    Check Your faxes  Thursday, March 30, 2017 
4183  NY  Huntington YMCA  7/15/2017    Check Your faxes  Friday, March 31, 2017 
4256  NY  Flushing YMCA  4/1/2018    Check Your faxes  Tuesday, March 28, 2017 
4396  NY  Southeast Family Branch YMCA  4/1/2018       
4421  NY  Guilderland YMCA  4/1/2018    Check Your faxes  Monday, March 27, 2017 
4422  NY  Greenbush Area YMCA  4/1/2018    Check Your faxes  Tuesday, March 28, 2017 
4425  NY  Duanesburg YMCA  4/1/2018       
4452  NY  Watertown Family YMCA  1/1/2018    Check Your faxes  Wednesday, March 29, 2017 
4480  NC  Western North Carolina YMCA  10/1/2017    Check Your faxes  Friday, March 31, 2017 
4500  NC  Alamance County Community YMCA  4/1/2018       
4519  NC  Lowe's YMCA  10/31/2017       
4549  NC  Greensboro YMCA  8/1/2017    Check Your faxes  Wednesday, March 29, 2017 
4579  NC  Hickory Foundation YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
4598  NC  Triangle Area YMCA  4/1/2017  Ins must be updated  Check Your faxes  Monday, March 27, 2017 
4600  NC  Twin Rivers NC YMCA  7/1/2017    Check Your faxes  Friday, March 31, 2017 
4614  NC  Rocky Mount Family YMCA  5/1/2017    Check Your faxes  Wednesday, March 22, 2017 
4626  NC  Northwest North Carolina YMCA  7/1/2017    Check Your faxes  Wednesday, March 29, 2017 
4699  OH  Cuyahoga Falls Riverfront YMCA  9/1/2017    Check Your faxes  Thursday, March 30, 2017 
4785  OH  North Canton Community YMCA  1/31/2018    Check Your faxes  Monday, March 27, 2017 
4795  OH  Auglaize Mercer Counties YMCA  4/1/2019    Check Your faxes  Tuesday, March 28, 2017 
4805  OH  Blue Ash YMCA  1/1/2018    Check Your faxes  Tuesday, March 28, 2017 
4817  OH  ME Lyons Anderson YMCA  1/1/2018    Check Your faxes  Tuesday, March 28, 2017 
4827  OH  Powel Crosley Jr YMCA  1/1/2018       
4891  OH  Geauga Branch YMCA  12/31/2017    Check Your faxes  Friday, March 31, 2017 
4953  OH  Gahanna YMCA  6/30/2017    Check Your faxes  Wednesday, March 29, 2017 
4954  OH  Hilliard YMCA  6/30/2017    Check Your faxes  Friday, March 24, 2017 
4974  OH  Liberty Township Powell YMCA  6/30/2017    Check Your faxes  Monday, March 27, 2017 
5004  OH  Kleptz YMCA  8/1/2017    Check Your faxes  Monday, March 27, 2017 
5018  OH  Coffman Family YMCA  8/1/2017    Check Your faxes  Tuesday, March 28, 2017 
5023  OH  South Family YMCA  8/1/2017       
5025  OH  Countryside Ralph Stolle YMCA  10/11/2017    Check Your faxes  Thursday, March 30, 2017 
5036  OH  Putnam County YMCA  8/21/2016  Ins must be updated     
5075  OH  Lake County East End YMCA  11/1/2017    Check Your faxes  Wednesday, March 22, 2017 
5083  OH  Lancaster and Fairfield YMCA  9/1/2017    Check Your faxes  Wednesday, March 22, 2017 
5087  OH  Lima Ohio YMCA  2/8/2016  Ins must be updated  Check Your faxes  Friday, March 31, 2017 
5107  OH  Marion Family YMCA  4/26/2017       
5155  OH  Miami County Ohio YMCA  3/1/2018       
5175  OH  Sidney and Shelby County YMCA  12/31/2017    Check Your faxes  Thursday, March 30, 2017 
5178  OH  Springfield Family YMCA  8/30/2017    Check Your faxes  Tuesday, March 28, 2017 
5243  OH  Tuscarawas County YMCA  3/7/2018    Check Your faxes  Friday, March 24, 2017 
5275  OH  Youngstown OH YMCA  10/6/2017    Check Your faxes  Friday, March 24, 2017 
5280  OH  Wapakoneta Family YMCA  12/22/2017       
5509  PA  Bethlehem YMCA  2/19/2017  Ins must be updated     
5517  PA  Bradford Family YMCA  2/1/2018    Check Your faxes  Tuesday, March 28, 2017 
5525  PA  Juniata Valley YMCA  5/15/2017    Check Your faxes  Tuesday, March 21, 2017 
5528  PA  Butler YMCA  11/1/2017    Check Your faxes  Saturday, April 1, 2017 
5545  PA  Carlisle Family YMCA  7/1/2017    Check Your faxes  Tuesday, March 28, 2017 
5549  PA  Chambersburg Memorial YMCA  10/20/2017    Check Your faxes  Friday, March 31, 2017 
5561  PA  Clearfield YMCA  4/15/2017    Check Your faxes  Thursday, March 30, 2017 
5566  PA  Jennersville YMCA  9/1/2017       
5575  PA  Corry YMCA  8/1/2017       
5603  PA  Grove City YMCA-PA  8/1/2017    Check Your faxes  Monday, March 27, 2017 
5605  PA  Freeland YMCA  3/19/2018    Check Your faxes  Wednesday, March 29, 2017 
5637  PA  West Shore YMCA  8/1/2017       
5643  PA  Bloomsburg Area YMCA  2/1/2018    Check Your faxes  Wednesday, March 29, 2017 
5647  PA  Indiana County YMCA  2/4/2014  Ins must be updated  Check Your faxes  Thursday, March 30, 2017 
5657  PA  Greater Johnstown Community  5/4/2017    Check Your faxes  Tuesday, March 28, 2017 
5673  PA  Lebanon Valley Family YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
5756  PA  Rocky Run YMCA  1/1/2018    Check Your faxes  Thursday, March 30, 2017 
5773  PA  Lansdowne YMCA  1/1/2018       
5781  PA  Ridley Area YMCA  1/1/2018       
5807  PA  Hatboro Area YMCA  1/1/2018       
5812  PA  Phoenixville Branch YMCA  1/1/2018       
5839  PA  Sampson Family YMCA  1/1/2018    Check Your faxes  Thursday, March 30, 2017 
5879  PA  South Hills Branch YMCA  1/1/2018       
5896  PA  Upper Perkiomen Valley YMCA  1/1/2018    Check Your faxes  Wednesday, March 29, 2017 
5907  PA  Reading and Berks County YMCA  1/1/2018    Check Your faxes  Wednesday, March 29, 2017 
5908  PA  Boyertown Area YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017 
5919  PA  Ridgway YMCA  4/1/2018    Check Your faxes  Monday, March 27, 2017 
5935  PA  Shenango Valley YMCA  3/31/2018    Check Your faxes  Monday, March 27, 2017 
5938  PA  State College Family YMCA  1/2/2018    Check Your faxes  Wednesday, March 29, 2017 
5939  PA  Pocono Family YMCA  3/1/2018    Check Your faxes  Tuesday, March 28, 2017 
5944  PA  Sunbury Branch YMCA  4/30/2017    Check Your faxes  Friday, March 31, 2017 
5961  PA  Uniontown Area YMCA  5/25/2017    Check Your faxes  Wednesday, March 29, 2017 
5966  PA  Lionville Community YMCA  9/1/2017       
5967  PA  Upper Main Line YMCA  9/1/2017    Check Your faxes  Wednesday, March 29, 2017 
5969  PA  Warren County YMCA  4/19/2017    Check Your faxes  Wednesday, March 29, 2017 
5985  PA  Kennett Area YMCA  9/1/2017       
5987  PA  Wilkes Barre Family YMCA  1/1/2018    Check Your faxes  Thursday, March 30, 2017 
5995  PA  York And York County YMCA  1/15/2018       
6030  RI  Newport County YMCA  8/1/2017    Check Your faxes  Wednesday, March 22, 2017 
6046  RI  Bayside Branch YMCA  8/31/2017    Check Your faxes  Thursday, March 23, 2017 
6070  RI  Kent County YMCA  8/31/2017    Check Your faxes  Monday, March 27, 2017 
6071  RI  South County RI YMCA  8/31/2017    Check Your faxes  Monday, February 27, 2017 
6082  SC  Anderson Area YMCA  1/15/2018    Check Your faxes  Monday, March 27, 2017 
6109  SC  Columbia Northwest Family YMCA  10/1/2017    Check Your faxes  Saturday, April 1, 2017 
6132  SC  Greater Spartanburg YMCA  8/1/2017    Check Your faxes  Saturday, April 1, 2017 
6152  SC  Rock Hill Aquatics Center  7/15/2017    Check Your faxes  Saturday, April 1, 2017 
6682  VA  Piedmont Family YMCA  6/20/2017    Check Your faxes  Friday, March 24, 2017 
6721  VA  Lynchburg YMCA  7/10/2017    Check Your faxes  Friday, March 24, 2017 
6731  VA  Martinsville and Henry Co YMCA  12/31/2017    Check Your faxes  Friday, March 31, 2017 
6798  VA  Salem Family Branch  9/1/2017    Check Your faxes  Tuesday, March 28, 2017 
6823  WA  Bremerton YMCA   12/31/2017    Check Your faxes  Thursday, March 30, 2017 
6855  WA  Skagit Valley Family YMCA  3/1/2018    Check Your faxes  Monday, March 20, 2017 
6971  WV  Beckley Raleigh County YMCA  7/1/2017       
6989  WV  Tri County YMCA Inc  7/1/2017    Check Your faxes  Friday, March 31, 2017 
7025  WV  Parkersburg YMCA  12/31/2017    Check Your faxes  Thursday, March 23, 2017 
7029  WV  Wheeling YMCA  9/15/2017    Check Your faxes  Friday, March 31, 2017 
7048  WI  Chippewa Valley Family YMCA  7/1/2017    Check Your faxes  Friday, March 24, 2017 
7049  WI  Eau Claire Wisconsin YMCA  8/1/2017    Check Your faxes  Friday, March 3, 2017 
7061  WI  Green Bay YMCA Metro  1/1/2018    Check Your faxes  Monday, March 27, 2017 
7066  WI  Door County YMCA  1/1/2018    Check Your faxes  Tuesday, March 21, 2017 
7073  WI  La Crosse Area Family YMCA  7/1/2017    Check Your faxes  Friday, March 31, 2017 
7125  WI  Schroeder YMCA   1/1/2018    Check Your faxes  Friday, March 24, 2017 
7155  WI  Oshkosh Community YMCA  1/1/2018    Check Your faxes  Saturday, April 1, 2017 
7159  WI  Racine Family YMCA  5/15/2017    Check Your faxes  Wednesday, March 29, 2017 
7169  WI  Stevens Point Area YMCA  1/1/2018    Check Your faxes  Monday, March 27, 2017