This form is to be signed by the appropriate people
YMCA Association #: ______________________
We the undersigned certify that each participant representing _____________ entered into 2019 YMCA Short Course National Championship:
COACHES: We attest that all coaches representing this YMCA at the YMCA National Championship Meet have cleared a background screening within the past 2 years. This background screening meets the standards set forth by USA Swimming.
AGREEMENT - Each team and each team member in applying for and entering this National YMCA sports competition does thereby agree to abide by and also support the standard that any person irrespective of race, color or creed shall be permitted to participate in this Championship providing each team member meets all conditions of eligibility and is properly qualified.
INSURANCE - Our Association now has insurance coverage for representative(s) including leadership and participants who will be in attendance at the 2019 YMCA Short Course National Championship for the period of meet. I hereby certify that YMCA has a minimum of $1,000,000/$2,000,000 in liability insurance that covers our coaches and swimmers during their participation in the 2019 YMCA Short Course National Championship. The YMCA of the USA must be named the Certificate Holder and also names the YMCA of the USA as an additional insured as it relates to this meet.
RELEASE - In consideration of your accepting this entry, I hereby, for myself, heirs, executor and administrators, waive and release any and all right and claim for damages I may have against the YMCA of the USA, and GREENSBORO AQUATIC CENTER, their agents, representatives or assigns for any and all injuries which may be suffered by participants at the 2019 YMCA Short Course National Championship. Furthermore we understand that the YMCA of the USA and GREENSBORO AQUATIC CENTER are not responsible for any intended or unintended consequences related to removing an athlete from competition for a head injury. This includes, but is not limited to, any financial reimbursement associated with such removal.
(signature, executive director) (please print legibly or type name here) date
(signature, membership director) (please print legibly or type name here) date
(signature, head coach) (please print legibly or type name here) date