YMCA National Swimming and Diving YMCA National Swimming and Diving YMCA NATIONAL CHAMPIONSHIP EVENTS

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Team Insurance List and Faxes Received

Insurances as: 3/31/2019 at 7:00AM

Declaration Forms Received as : 3/31/2019 at 7:00AM

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 Sam Mars .
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
0124  AL  Prattville YMCA  3/31/2020    Check Your faxes  Thursday, March 28, 2019 
0153  AK  Anchorage Alaska YMCA  10/1/2017  Ins must be updated     
0951  CT  Greenwich YMCA  1/1/2020    Check Your faxes  Thursday, March 21, 2019 
0964  CT  Farmington Valley Branch YMCA  1/1/2020       
0976  CT  Cheshire YMCA  1/1/2020       
0983  CT  Laurel East Hartford YMCA  1/1/2020    Check Your faxes  Thursday, March 21, 2019 
0989  CT  New Canaan Community YMCA  11/7/2019       
0996  CT  Soundview Family YMCA  5/1/2019    Check Your faxes  Tuesday, March 26, 2019 
1024  CT  Wilton Family YMCA  12/29/2019    Check Your faxes  Tuesday, March 26, 2019 
1033  CT  Regional YMCA of Western Connecticut  7/1/2019       
1041  CT  Southington Cheshire YMCAs  1/1/2020       
1061  CT  Wallingford Family YMCA  7/1/2014  Ins must be updated     
1069  CT  Westport Weston CT YMCA  4/1/2019  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
1089  DE  Brandywine DE YMCA  8/1/2019    Check Your faxes  Thursday, March 28, 2019 
1105  DE  Western Branch YMCA  8/1/2019    Check Your faxes  Wednesday, March 27, 2019 
1126  VA  Fairfax County YMCA in Reston  10/1/2019    Check Your faxes  Wednesday, March 27, 2019 
1245  FL  South Florida YMCA  3/31/2020    Check Your faxes  Friday, March 29, 2019 
1285  FL  Central Florida Metro YMCA  6/1/2019    Check Your faxes  Monday, March 25, 2019 
1333  FL  Sarasota Family YMCA  7/1/2018  Ins must be updated     
1335  FL  South County Family YMCA - FL  4/13/2019    Check Your faxes  Wednesday, March 27, 2019 
1382  GA  Georgia's Piedmont YMCA  1/1/2020    Check Your faxes  Friday, February 15, 2019 
1526  ID  Boise Family YMCA  12/31/2019    Check Your faxes  Thursday, March 21, 2019 
1575  IL  Champaign County YMCA  3/1/2020       
1580  IL  Sage YMCA  10/1/2019    Check Your faxes  Monday, March 25, 2019 
1743  IL  Kishwaukee Family YMCA  9/5/2019       
1755  IL  Edwardsville YMCA  2/1/2020       
1767  IL  Fayette County Family YMCA  3/19/2020    Check Your faxes  Tuesday, March 26, 2019 
1775  IL  Tri City Area IL YMCA  7/1/2019    Check Your faxes  Friday, March 29, 2019 
1785  IL  Joliet YMCA  7/1/2019    Check Your faxes  Friday, March 29, 2019 
1843  IL  BR Ryall NW Dupage YMCA  1/20/2020    Check Your faxes  Monday, March 25, 2019 
1871  IL  Rock River Valley YMCA  9/1/2019    Check Your faxes  Tuesday, March 26, 2019 
1879  IL  Springfield IL YMCA  1/1/2020    Check Your faxes  Thursday, March 28, 2019 
2135  IA  Central Branch YMCA  5/1/2019    Check Your faxes  Tuesday, March 26, 2019 
2165  IA  Greater Des Moines Iowa YMCA  6/3/2019    Check Your faxes  Saturday, March 23, 2019 
2217  IA  Ottumwa Iowa YMCA  12/1/2019    Check Your faxes  Monday, March 18, 2019 
2337  KY  Ashland Area YMCA  7/15/2018  Ins must be updated     
2353  KY  RC Durr Family YMCA  1/1/2020       
2491  LA  YMCA OF NORTHWEST LOUISIANA - Red River Aquatics Club  7/1/2019    Check Your faxes  Thursday, March 21, 2019 
2512  ME  Waterville Area YMCA  4/1/2020    Check Your faxes  Tuesday, March 19, 2019 
2513  ME  Old Town Orono YMCA  11/21/2019       
2517  ME  Down East Family YMCA  1/1/2020    Check Your faxes  Monday, March 25, 2019 
2521  ME  Kennebec Valley YMCA  1/1/2020    Check Your faxes  Monday, March 25, 2019 
2525  ME  Auburn Lewiston Twin Cities YMCA  6/13/2019    Check Your faxes  Thursday, March 21, 2019 
2537  ME  Bath Area Family YMCA  11/13/2019    Check Your faxes  Thursday, March 14, 2019 
2581  MD  YMCA in Central Maryland  11/1/2019       
2583  MD  SPY Greater Annapolis YMCA  11/1/2019       
2605  MD  Cumberland MD YMCA  7/11/2019    Check Your faxes  Friday, March 29, 2019 
2615  MD  Cecil County YMCA  12/31/2019    Check Your faxes  Tuesday, March 26, 2019 
2619  MD  Hagerstown Maryland YMCA  6/13/2019    Check Your faxes  Thursday, March 21, 2019 
2623  MD  Frederick County YMCA  7/1/2019    Check Your faxes  Wednesday, March 27, 2019 
2626  MD  Richard A Henson Family YMCA  12/31/2019    Check Your faxes  Friday, March 29, 2019 
2631  MD  Talbot County YMCA  12/31/2019    Check Your faxes  Sunday, March 24, 2019 
2793  MA  Malden YMCA  4/1/2016  Ins must be updated  Check Your faxes  Tuesday, March 26, 2019 
2849  MA  South Shore MA YMCA  1/1/2020       
2853  MA  Burbank Branch YMCA  9/30/2019    Check Your faxes  Saturday, March 23, 2019 
2857  MA  MetroWest YMCA  1/1/2020    Check Your faxes  Monday, March 25, 2019 
2861  MA  North Shore Sterling MA YMCA  3/1/2020    Check Your faxes  Thursday, March 28, 2019 
2957  MI  Birmingham Family YMCA  8/1/2019    Check Your faxes  Tuesday, March 26, 2019 
2973  MI  Farmington Family YMCA  8/1/2019    Check Your faxes  Wednesday, March 27, 2019 
3031  MI  Rapid Area YMCA  8/1/2018  Ins must be updated     
3105  MI  North Oakland Family YMCA  8/1/2019       
3117  MI  Saginaw YMCA  5/1/2019    Check Your faxes  Saturday, March 23, 2019 
3179  MN  Southdale Branch YMCA  1/1/2020    Check Your faxes  Thursday, March 28, 2019 
3406  MO  O'Fallon Family YMCA  7/1/2019    Check Your faxes  Thursday, March 28, 2019 
3477  NE  Grand Island Nebraska YMCA  1/1/2020    Check Your faxes  Saturday, March 30, 2019 
3641  NJ  Burlington Camden County YMCA  1/1/2020    Check Your faxes  Thursday, March 28, 2019 
3685  NJ  Fanwood Scotch Plains YMCA  4/15/2019    Check Your faxes  Wednesday, March 27, 2019 
3689  NJ  Western Monmouth Co YMCA  3/31/2019  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
3725  NJ  Meadowlands Area YMCA    Ins must be updated  Check Your faxes  Saturday, March 30, 2019 
3729  NJ  Wyckoff Family YMCA Inc  4/1/2020    Check Your faxes  Tuesday, March 26, 2019 
3741  NJ  Hunterdon County YMCA  8/1/2019    Check Your faxes  Wednesday, March 27, 2019 
3753  NJ  Lakeland Hills Family YMCA  1/1/2020    Check Your faxes  Wednesday, March 27, 2019 
3765  NJ  Hamilton Area NJ YMCA  5/15/2019    Check Your faxes  Thursday, March 28, 2019 
3779  NJ  Princeton Family YMCA  12/31/2003  Ins must be updated  Check Your faxes  Saturday, March 23, 2019 
3786  NJ  Metuchen Edison YMCA  3/31/2020       
3791  NJ  Montclair YMCA  3/31/2020    Check Your faxes  Thursday, March 21, 2019 
3795  NJ  Randolph YMCA  1/1/2020    Check Your faxes  Tuesday, March 19, 2019 
3832  NJ  Sussex County Branch YMCA  6/1/2019    Check Your faxes  Saturday, March 23, 2019 
3863  NJ  Ocean County YMCA  10/1/2019       
3883  NJ  Red Bank Branch YMCA  8/1/2019    Check Your faxes  Saturday, March 23, 2019 
3885  NJ  Ridgewood NJ YMCA  8/1/2019    Check Your faxes  Friday, March 29, 2019 
3915  NJ  Somerset Hills YMCA  4/1/2019  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
3919  NJ  Somerset Valley YMCA  4/1/2019  Ins must be updated  Check Your faxes  Thursday, March 28, 2019 
3928  NJ  Summit Branch YMCA  7/1/2019    Check Your faxes  Tuesday, March 26, 2019 
3947  NJ  Vineland YMCA  1/1/2017  Ins must be updated     
3951  NJ  Westfield YMCA  12/31/2019    Check Your faxes  Tuesday, March 26, 2019 
3998  NY  Skaneateles YMCA  3/1/2019  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
4063  NY  Greater Canandaigua YMCA  4/1/2020    Check Your faxes  Tuesday, March 26, 2019 
4073  NY  Clifton Springs Area YMCA  7/1/2019    Check Your faxes  Monday, March 25, 2019 
4115  NY  Glens Falls YMCA  8/31/2019    Check Your faxes  Friday, March 29, 2019 
4181  NY  East Hampton RECenter YMCA  5/15/2019    Check Your faxes  Friday, March 29, 2019 
4183  NY  Huntington YMCA  5/15/2019    Check Your faxes  Friday, March 29, 2019 
4242  NY  Cross Island YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
4256  NY  Flushing YMCA  1/1/2020    Check Your faxes  Tuesday, March 26, 2019 
4368  NY  Greater Rochester YMCA  4/1/2019  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
4408  NY  Rye NY YMCA  7/1/2013  Ins must be updated     
4425  NY  Duanesburg YMCA  4/1/2020       
4470  NC  YMCA of Asheboro NC Inc  3/18/2020    Check Your faxes  Friday, March 29, 2019 
4480  NC  Western North Carolina YMCA  10/1/2019    Check Your faxes  Monday, March 25, 2019 
4500  NC  Alamance County Community YMCA  4/1/2020    Check Your faxes  Friday, March 22, 2019 
4519  NC  Lowes YMCA  10/31/2019    Check Your faxes  Tuesday, March 26, 2019 
4546  NC  Goldsboro Family YMCA  1/1/2020    Check Your faxes  Wednesday, March 27, 2019 
4549  NC  Greensboro YMCA  8/1/2019       
4579  NC  Hickory Foundation YMCA  1/1/2020    Check Your faxes  Thursday, March 28, 2019 
4598  NC  Triangle Area YMCA  4/1/2020       
4614  NC  Rocky Mount Family YMCA  5/1/2019    Check Your faxes  Monday, March 18, 2019 
4622  NC  Wilmington YMCA NC  8/1/2019    Check Your faxes  Friday, March 29, 2019 
4626  NC  Northwest North Carolina YMCA  7/1/2019    Check Your faxes  Thursday, March 28, 2019 
4710  OH  Green Family YMCA  9/1/2019    Check Your faxes  Saturday, March 30, 2019 
4772  OH  Meyers Lake YMCA  1/31/2020    Check Your faxes  Monday, March 25, 2019 
4780  OH  Jackson Community YMCA  1/31/2020    Check Your faxes  Tuesday, March 26, 2019 
4785  OH  North Canton Community YMCA  1/31/2020    Check Your faxes  Tuesday, March 26, 2019 
4795  OH  Auglaize Mercer Counties YMCA  4/1/2020    Check Your faxes  Tuesday, March 26, 2019 
4805  OH  Blue Ash YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
4817  OH  ME Lyons Anderson YMCA  1/1/2020       
4827  OH  Powel Crosley Jr YMCA  1/1/2020       
4953  OH  Gahanna YMCA  6/30/2019    Check Your faxes  Saturday, March 30, 2019 
4974  OH  Liberty Township Powell YMCA  6/30/2019    Check Your faxes  Friday, March 29, 2019 
5018  OH  Coffman Family YMCA  8/1/2019       
5023  OH  South Family YMCA  8/1/2019    Check Your faxes  Friday, March 29, 2019 
5025  OH  Countryside Ralph Stolle YMCA  10/11/2019    Check Your faxes  Thursday, March 28, 2019 
5065  OH  Great Miami Valley Ohio YMCA  11/1/2019    Check Your faxes  Tuesday, March 26, 2019 
5079  OH  Lake County West End YMCA  11/1/2019    Check Your faxes  Friday, March 22, 2019 
5083  OH  Lancaster and Fairfield YMCA  9/1/2020    Check Your faxes  Thursday, March 28, 2019 
5109  OH  Union County Family YMCA  10/31/2019       
5155  OH  Miami County Ohio YMCA  3/1/2021       
5178  OH  Springfield Family YMCA  8/30/2020    Check Your faxes  Friday, March 29, 2019 
5203  OH  Tiffin Community YMCA  12/1/2018  Ins must be updated     
5222  OH  Fort Meigs YMCA  9/15/2019    Check Your faxes  Tuesday, March 26, 2019 
5243  OH  Tuscarawas County YMCA  3/7/2021    Check Your faxes  Tuesday, March 26, 2019 
5254  OH  Lakota Family YMCA  9/30/2019       
5259  OH  Wooster Ohio YMCA  7/1/2013  Ins must be updated     
5275  OH  Youngstown OH YMCA  10/6/2017  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
5478  PA  Central Bucks Family YMCA  9/1/2019    Check Your faxes  Thursday, March 28, 2019 
5509  PA  Bethlehem YMCA  2/19/2020    Check Your faxes  Friday, March 29, 2019 
5517  PA  Bradford Family YMCA  2/1/2020    Check Your faxes  Wednesday, March 27, 2019 
5545  PA  Carlisle Family YMCA  7/1/2019    Check Your faxes  Saturday, March 23, 2019 
5549  PA  Chambersburg Memorial YMCA  10/20/2019    Check Your faxes  Thursday, March 21, 2019 
5561  PA  Clearfield YMCA  4/15/2019       
5566  PA  Jennersville YMCA  9/1/2019    Check Your faxes  Friday, March 29, 2019 
5602  PA  Franklin YMCA  8/1/2019    Check Your faxes  Saturday, March 23, 2019 
5603  PA  Grove City YMCA-PA  8/1/2019    Check Your faxes  Monday, March 25, 2019 
5605  PA  Freeland YMCA  3/19/2020    Check Your faxes  Monday, March 25, 2019 
5637  PA  West Shore YMCA  8/1/2019       
5643  PA  Bloomsburg Area YMCA  2/1/2020    Check Your faxes  Friday, March 22, 2019 
5645  PA  Blair Regional YMCA  1/1/2020    Check Your faxes  Wednesday, March 27, 2019 
5647  PA  Indiana County YMCA  2/4/2020    Check Your faxes  Thursday, March 28, 2019 
5649  PA  Jersey Shore YMCA  1/1/2020    Check Your faxes  Monday, March 25, 2019 
5657  PA  Greater Johnstown Community  5/4/2019    Check Your faxes  Friday, March 29, 2019 
5667  PA  Lancaster Family YMCA  8/15/2019       
5695  PA  Tri Hampton Family YMCA  9/1/2019    Check Your faxes  Thursday, March 28, 2019 
5701  PA  Meadville YMCA  11/1/2019    Check Your faxes  Thursday, March 28, 2019 
5715  PA  Nazareth/Easton YMCA  2/19/2020       
5723  PA  New Castle Community YMCA  2/1/2020    Check Your faxes  Thursday, March 21, 2019 
5756  PA  Rocky Run YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
5781  PA  Ridley Area YMCA  1/1/2019  Ins must be updated     
5812  PA  Phoenixville Branch YMCA  1/1/2020    Check Your faxes  Saturday, March 30, 2019 
5896  PA  Upper Perkiomen Valley YMCA  1/1/2020    Check Your faxes  Wednesday, March 27, 2019 
5907  PA  Reading and Berks County YMCA  1/1/2020       
5908  PA  Boyertown Area YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
5927  PA  Greater Scranton YMCA  5/31/2019    Check Your faxes  Thursday, March 28, 2019 
5928  PA  Schuylkill YMCA  9/1/2018  Ins must be updated  Check Your faxes  Tuesday, March 26, 2019 
5938  PA  State College Family YMCA  1/2/2020    Check Your faxes  Monday, March 25, 2019 
5939  PA  Pocono Family YMCA  3/1/2020    Check Your faxes  Wednesday, March 27, 2019 
5944  PA  Greater Susquehanna Valley YMCA  4/30/2019    Check Your faxes  Thursday, March 28, 2019 
5953  PA  Titusville YMCA  3/1/2020    Check Your faxes  Tuesday, March 26, 2019 
5966  PA  Lionville Community YMCA  9/1/2019       
5967  PA  Upper Main Line YMCA  9/1/2019    Check Your faxes  Tuesday, March 26, 2019 
5985  PA  Kennett Area YMCA  9/1/2019    Check Your faxes  Monday, March 25, 2019 
5986  PA  West Chester Area YMCA  9/1/2019    Check Your faxes  Friday, March 29, 2019 
5987  PA  Wilkes Barre Family YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
5992  PA  Eastern Lycoming YMCA   1/1/2020    Check Your faxes  Tuesday, March 26, 2019 
5995  PA  York And York County YMCA  1/15/2020    Check Your faxes  Friday, March 29, 2019 
5997  PA  Hanover Area YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
6030  RI  Newport County YMCA  8/1/2019    Check Your faxes  Wednesday, March 27, 2019 
6046  RI  Bayside Branch YMCA  8/31/2019    Check Your faxes  Tuesday, March 26, 2019 
6071  RI  South County RI YMCA  8/31/2019    Check Your faxes  Thursday, March 21, 2019 
6076  RI  Westerly Pawcatuck YMCA  1/1/2020    Check Your faxes  Friday, March 29, 2019 
6109  SC  Columbia Northwest Family YMCA  1/1/2020       
6132  SC  Greater Spartanburg YMCA  8/1/2019    Check Your faxes  Tuesday, March 26, 2019 
6152  SC  Rock Hill Aquatics Center YMCA  7/15/2019       
6663  VT  Greater Burlington YMCA  11/1/2019       
6682  VA  Piedmont Family YMCA  12/31/2019    Check Your faxes  Tuesday, March 26, 2019 
6721  VA  Lynchburg YMCA  7/10/2019       
6798  VA  Salem Family YMCA  9/1/2019    Check Your faxes  Tuesday, March 19, 2019 
6807  VA  Waynesboro Family YMCA  1/26/2018  Ins must be updated  Check Your faxes  Thursday, March 28, 2019 
6823  WA  Bremerton YMCA   12/31/2019    Check Your faxes  Saturday, March 23, 2019 
6855  WA  Skagit Valley Family YMCA  3/1/2020    Check Your faxes  Saturday, March 16, 2019 
6979  WV  Kanawha YMCA  10/1/2019    Check Your faxes  Saturday, March 23, 2019 
6989  WV  Tri County YMCA Inc  7/1/2019    Check Your faxes  Thursday, March 21, 2019 
6999  WV  Elkins West Virginia YMCA  1/1/2020    Check Your faxes  Thursday, March 21, 2019 
7007  WV  Harrison Area YMCA  8/1/2018  Ins must be updated  Check Your faxes  Tuesday, March 26, 2019 
7025  WV  Parkersburg YMCA  12/31/2019    Check Your faxes  Saturday, March 23, 2019 
7029  WV  Wheeling YMCA  9/15/2018  Ins must be updated  Check Your faxes  Friday, March 29, 2019 
7033  WI  Fox Cities YMCA  9/1/2018  Ins must be updated     
7048  WI  Chippewa Valley Family YMCA  7/1/2019    Check Your faxes  Thursday, March 21, 2019 
7049  WI  Eau Claire Wisconsin YMCA  8/1/2019    Check Your faxes  Tuesday, March 12, 2019 
7061  WI  Green Bay YMCA Metro  1/1/2020       
7066  WI  Door County YMCA  1/1/2019  Ins must be updated  Check Your faxes  Wednesday, March 27, 2019 
7101  WI  Manitowoc Two Rivers Area YMCA  12/31/2019    Check Your faxes  Thursday, March 21, 2019 
7125  WI  Schroeder YMCA   1/1/2020    Check Your faxes  Monday, March 25, 2019 
7159  WI  Racine Family YMCA  5/15/2019    Check Your faxes  Monday, March 25, 2019 
7169  WI  Stevens Point Area YMCA  1/1/2020    Check Your faxes  Wednesday, March 27, 2019 
7179  WI  Wausau Woodson YMCA  6/30/2019    Check Your faxes  Tuesday, March 26, 2019