EDWARDSVILLE YMCA BREAKERS PRESENTS: The Heartland …€¦ · Results: Event results will be...
Transcript of EDWARDSVILLE YMCA BREAKERS PRESENTS: The Heartland …€¦ · Results: Event results will be...
EDWARDSVILLE YMCA BREAKERS PRESENTS:
The Heartland Area Championship Swim Meet
March 17th-19th, 2017 Ozark LSC Sanction #OZ –
YMCA SC Sanction #
Assigned
Positions:
Meet Referee: John Lynch
Admin Referee: Dana LeVasseur
Meet Director: Dave Baggette
Safety Marshall: Marsha Billhartz
Location:
Charles Fruit Aquatic Center
6168 Center Grove Road
Edwardsville, IL 62025 618-656-436
Directions:
From I-270 exit 157 north. Take Hwy 157 approximately 3.5 miles north. Turn right onto Center Grove
Road. Go to the next stop light and take a left, entering into the District 7 Sports Complex. The Chuck Fruit
Aquatic Center will be on your left hand side. Parking is either the first left as you enter, or, you can go
through the gates and you will find more parking.
Facility:
A 50 meter pool separated by two bulkheads, creating an 8 lane and 6 lane, 25 yard competition courses
with competitive non-turbulent lane markers and electronic Timing System with touchpads, beep start
system and a full matrix lane scoreboard. A warm-up/warm-down pool is also available in the south pool
lane 8 while the meet is running. No cell phone use will be allowed in locker rooms.
Meet Safety: In accordance with the recommendations of USA Swimming and YMCA Swimming, this meet will
operate under the guidance of a Safety Marshall. Per USA and YMCA policy, cell phones with video
and video recording devices are prohibited in all locker rooms and from behind the blocks.
Operation of a drone, or any other flying apparatus, is prohibited over the venue (pools,
athlete/coach areas, spectator areas and open ceiling locker rooms) any time athletes, coaches,
officials and/or spectators are present.
*******No deck changing permitted********
Changing into or out of swimsuits other than in locker rooms or other designated areas is prohibited.
Warm up: Warm up lanes will be assigned and posted on the Breakers website, www.edwyswim.org. 2016/2017
USA Swimming Rules and “Rules That Govern YMCA Swimming” will govern Procedures along with
our Area YMCA rules and bylaws. All unaccompanied swimmers must report to the meet referee prior to
warming up for the first session in which they are swimming. The meet referee shall instruct swimmer in
safety rules for meet and assign to warm up lanes.
Entries: ENTRY DEADLINE: Wednesday, March 8th, 2017 at 6:00 PM.
Exhibition swimming is prohibited. Swimmers may compete in seven total individual events during
the meet and two relay events per day. Each team may enter one (1) relay team per relay event. A
swimmer’s age as of December 1, 2016 determines the age group for competition. Swimmers must
meet all the Heartland Area YMCA and “The Rules that Govern Competitive Sports” eligibility
requirements. In individual events, a swimmer may only swim in one competitive age group. In case of
12 year olds, they may swim in the 15-21 events that are not being held in their age group. In relay
events, a swimmer may swim up one age group (or two age groups for 11-12’s only). The 8 & under
and 9-10 age groups cannot swim up 2 age groups. NO DECK ENTRIES PERMITTED.
Qualifying
Times:
An athlete must achieve the minimum qualifying time standard for each Championship Meet event in
which he/she enters. The qualification period for the Area Championship Meet is March 1st of the
preceding year (2016) through the last day of the 2017 Heartland Area Regional Championship Meets.
Qualifying times can be found in this packet and on the YMCA Heartland Area Swim Committee website,
http://www.teamunify.com/SubTabGeneric.jsp?team=reczzhascil&_stabid_=110586. Coaches must be
able to show proof of time through Hy-tek meet result if asked. SCM times will be accepted, but they
must be submitted as SCM times. HY-Tek conversion factors will be used as is the case with Y
Nationals. Y to SCM = 1.11, 400/500 800/1000 = .875, 1650/1500 = .997. SCM times will be seeded
after SCY times. No LCM times will be accepted.
Procedure: DO NOT SEND ANY ENTRIES VIA POSTAL MAIL!
Entries are to be submitted on HYTEK compatible format. All entries are to be sent via e-mail. If
submitting written entry please type a word file. You must include complete names and birthdates of
swimmers. E-mail your entry to [email protected] . If assistance is needed, please contact Bob
Rettle at 618-407-7665(C), or by email, [email protected]. Fees must be turned in before the
Friday evening session begins, or before the first session your swimmers compete in. Make check Payable
to EDWY Swim Team and send payments via postal mail to:
EDWY Breakers
17 Junction Dr #235
Glen Carbon, IL 62034
Coaches must review their entries, no changes will be allowed after Saturday, March 11th, 2017 at
10:00 PM. There will be NO exceptions since this is a pre-seeded meet. Meet information and TM
Event file at: www.edwyswim.org – Area Meet Tab
Coaches:
Per Heartland Area rules, only certified coaches and meet officials will be permitted on the main pool
deck during the meet. Coaches are not allowed behind starting blocks at the start of race. Coaches must
receive coaches’ clearance of certification from Aaron Heiss – [email protected]. Deck passes will
only be issued to qualified coaches that meet all certification requirements. There will be a hospitality
room for coaches and meet officials only.
Fees: $7.00 per individual event and $21.00 per relay and a $10.00 per swimmer surcharge.
Heat Sheet: Heat sheets will be sold for $15.00 for the entire weekend. This will include heat sheets for any returning
swimmers for Finals Saturday and Sunday night.
NO GATE ENTRY FEE INTO FACILITY
Eligibility:
Open to all swimmers who are YMCA members. Swimmers age as of December 1, 2016 will determine age group for the meet. Swimmers must compete in the age groups that fit their age group description.
“Swimming up” is permitted in relays as described in YMCA Rules.
Seeding:
The meet will be pre-seeded with Friday evening’s 200, 500 free, 200 and 400 IM will be swum in the
event order listed, but swum fastest heat to slowest heat. The 1000 and 1650’s are swum fast to slow.
Results: Event results will be posted outside the hospitality room. Complete results will be available for coaches at
the conclusion of the meet and on the Breakers website: www.edwyswim.org under the 2017 Heartland
Area tab
Concessions: Full concessions will be available during the three-day event.
Vendors: Onsite vendors over the weekend.
• B & B Aquatics – Swim equipment and apparel.
• Fine Designs – Area Meet T-Shirts, Sweatshirts, etc – Will share Area Logo once completed
• St. Louis Digital – For pictures of your swimmers during competition.
Awards and
Scoring: Points and awards will be rewarded to the top 16 finishers in each
event.
Individual Events: 20-17-16-15-14-13-12-11-9-7-6-5-4-3-2-1
Relay Events: 40-34-32-30-28-26-24-22-18-14-12-10-8-6-4-2
Awards: Individual & Relays - 1st-8th place Championship Medals 9th-16th place Special Ribbons
Age Group Awards: 1st-3rd place Team Trophies, separate boys/girls
Team Awards: 1st-3rd place Team Trophies, boys/girls combined
All age group and team trophies will be presented after the conclusion of finals on Sunday (the 8 & Under
and 9-10 Age group will be given after their afternoon timed final session on Sunday). Coaches or a
predesignated parent only may pick up individual awards following the completion of finals. All teams will
receive one copy of total meet results on Sunday. Teams may bring 1 disk/thumb drive for computer results
of the meet to pick up Sunday with awards. Please be sure to label your device for pick up. During the meet,
results of each event will be posted in the team area for spectators and swimmers and on deck for coaches.
Swimming
Schedule:
All Friday night events are timed finals. Saturday and Sunday morning events will be swum as prelim/finals,
except for all of the Relays, the 1000, 1650 Freestyle, and the 200 Fly, Back, Breast events. ALL 8 &
UNDER AND 9-10 EVENTS WILL BE SWUM AS TIMED FINALS during the afternoon sessions.
• Swimmers who place in the top 16 of each prelim event on Saturday and Sunday will qualify for finals to be
swum that evening of prelims.
• Swimmers with at least one meet qualifying time will be granted one bonus swim. Swimmers are still
subject to meet and session event limits.
• Two alternates will be assigned to each event (next two swimmers after 16th place). Once a prelim event has
completed, the top 16 swimmers and the 2 alternates will be announced.
• Swimmers chosen for finals, consolation finals, or as alternates have 30-minutes to scratch once the
announcement has been made. If necessary, additional swimmers will be chosen and announced -- they will
have 30-minutes to scratch once chosen and announced.
• Any swimmer, other than an alternate, who qualifies for finals or consolation finals, who does not scratch,
and does not participate in the finals event, will be removed from participating in the remainder of the meet.
• In the event that there is a no show for finals, swimmers from consolation finals will be moved into finals,
and alternates will be moved into the consolation finals.
• Alternates will not be penalized for a 'no show' if called upon to participate in finals and they are not present.
• Girls will swim prelims in the North Pool and the boys will swim prelims in the South Pool
• All finals will be swum in the North Pool.
• The 10 and under session will be swam in the North Pool, but is subject to change based on the number of
entries.
• Declared false starts may be used for prelim, timed final and swim-off events.
• Declared false starts cannot be used for final or consolation final events.
• Official scratch sheets will be provided at the meet and must be turned in regardless of whether or not a team
has scratches for that session.
• Scratch sheets must be turned in to the Administrative Referee one (1) hour prior to the start of the session.
• A no-show in prelims or a timed finals event only removes that swimmer from that event. A no show in a
finals event will remove that swimmer from the remainder of the meet.
• This will be an USA Swimming approved meet. Those teams that want their swimmers swims observed and
times recorded in the USA Swimming data base (SWIMS) must provide the name (first, middle, last), date
of birth, and USA Swimming athlete registration number with their meet entries. Please do not build an ID
in Team Manager if the swimmers are not registered with USA Swimming as this will delay the process of
getting times submitted into SWIMS.
• Senior Awards will be given on Saturday near the end of or at the end of the Preliminary Session.
Time Trial:
• Time trials will be held at the end of the session each day of the meet for events 500 yards and down.
• Swimmers participating in time trials must be 12 years or older and have a current swim time meeting the
13-14 age group Heartland area qualifying time.
o Only open to those entered into the Heartland Area Meet
o Time trial fees are as follows: $10 per splash, $25 per relay.
Rules: The 2016/2017 USA Swimming Rules shall govern this meet as dictated by “Rules That Govern
YMCA Swimming”.
• No flash or lighted cameras, smart phones, tablets, or other devices may be used at any time during the
meet.
• No shaving will be allowed on meet premises.
• No recording devices, cameras, including cell phones, of any type will be allowed in the locker rooms or
behind the blocks.
• Smoking is PROHIBITED on all District 7 facilities.
• NO SWIM BAGS in the Spectator mezzanine area.
• Failure to follow these rules will result in immediate removal from the Aquatic center and denial of reentry.
Bull Pen: All Swimmers in 10 and under events must report to the bullpen. Swimmers are REQUIRED to report to the
ready room during finals. There will be NO bullpen on Friday night or during Prelims, swimmers will report
to the blocks when event is called.
Important
Dates: Wednesday, March 8th, 2017 – Entries Due
Saturday, March 11th, 2017 – Deadline for changes to entries
Wednesday, March 15th, 2017 – Psych Sheet posted on website (If all call ups are completed to fill meet)
Wednesday, March 15th, 2017 – Warm up Schedule Posted based on swimmers entered per team
Meet Information: Seating for 499 Spectators in the mezzanine area above the pools. Swimmers must use the pool deck to
keep their swim bags and other belongings.
• Meet Programs will be sold for $15.00 for the entire meet, including the Finals for Saturday and Sunday
evening.
• Final Heat Sheets will be made available before the beginning of the Finals warm Up Sessions start.
• No entry fee into the Aquatic Center for the meet.
• Swimmers in the 500, 1000, and the 1650 freestyle must provide their own lap counters.
• Teams will be asked to provide timers. The number of timers will be based on the entry size.
Crash Area: There will be a gym for swimmer and spectator crash area and pool deck to be used as crash area for the
swimmers only. All swimmers must use the POOL DECK as their crash area to keep their swim bags. The
gym will be available for team crash area. Each team will be assigned a designated area based upon the
number of athletes participating in the meet. The spacing of the designated area will be marked, and may not
be altered. Lawn chairs may be brought into each team's designated area. No cots or tents will be allowed
in the crash area. Parents and swimmers will not be allowed to set up a crash area in the spectators’ area, in
walk ways, in any designated exit areas, or other unauthorized areas as designated by the Chuck Fruit
Aquatic Center Staff.
Officials: Each team is required to supply certified officials for the Area Swim Championships. A separate form
related to officials is attached and must be sent to:
John E Lynch, Jr.
12 Joan Dr.
New Baden, IL 62265
618-792-4222 (cell)
E-mail: [email protected]
E-mail submissions for officials will be accepted in lieu of the paper form. Officials’ submissions via e-mail
should be made to [email protected] An officials form must be received by John Lynch, no later
than March 8th, 2017, 8 pm or your team will be subject to the $100.00 late fee for the Area Meet. Failure to
return this form will result in your team not being entered in the Area Meet.
Liability:
The Edwardsville YMCA, District 7 School District, Chuck Fruit Aquatic Center and the Heartland Area
Swim Committee do not assume any responsibility for injury and lost or stolen articles.
Time Schedule:
NOTE: The timeline may be adjusted as necessary depending on number of entries received
Fri., March 17th, 2017 – Timed Finals
All Age Groups
4:30-5:50 P.M. Warm ups
5:00 P.M. Officials Meeting
5:45 P.M. 1st Event Called
6:00 P.M. Meet Begins
Immediately following last event— Time Trial
Immediately Following Time Trial - Mandatory Coaches Meeting
Sat., March 18th, 2017 - PRELIMS
11 and OLDER Only
6:30-7:50 A.M. Warm Ups
7:00 A.M. Officials Meeting
7:30 A.M. Scratch/Relays Due
7:50 A.M. 1st Event Called 8:00 A.M. Meet Begins
Official scratch sheets must be turned in regardless of whether or not a team has scratches for that session.
Sat., March 18th, 2017 – TIMED FINALS
8 and UNDER with 9-10 Age Group
11:00-12:15 P.M. Warm Ups
11:15 A.M. Officials Meeting
11:30 A.M. Scratch/Relays Due 12:15 P.M. 1st Event Called 12:30 P.M. Meet Begins
Official scratch sheets must be turned in regardless of whether or not a team has scratches for that session.
Sat., March 18th, 2017 –FINALS
11 AND OVER ONLY
4:00-4:50 P.M. Warm Ups (see schedule)
4:15 P.M. Officials Meeting
4:45 P.M. 1st Event Called
5:00 P.M. Meet Begins
Immediately following last event— Time Trial (if necessary)
Sunday, March 19th, 2017 - PRELIMS
11 AND OVER ONLY
6:30-7:50 A.M. Warm Ups
7:00 A.M. Officials Meeting
7:30 A.M. Scratch/Relays Due
7:50 A.M. 1st Event Called 8:00 A.M. Meet Begins
Official scratch sheets must be turned in regardless of whether or not a team has scratches for that session.
Sunday, March 19th, 2017 – TIMED FINALS
8 and UNDER with 9-10 Age Group
11:00-12:15 P.M. Warm Ups
11:15 A.M. Officials Meeting
11:30 A.M. Scratch/Relays Due
12:15 P.M. 1st Event Called 12:30 P.M. Meet Begins
Official scratch sheets must be turned in regardless of whether or not a team has scratches for that session.
Sunday, March 19th, 2017 –FINALS
11 AND OVER ONLY
4:00-4:50 P.M. Warm Ups (see schedule)
4:15 P.M. Officials Meeting
4:45 P.M. 1st Event Called
5:00 P.M. Meet Begins
Immediately following last event— Time Trial (if necessary)
Friday Night Timed Finals
Girls Qualifying Time Event Qualifying Time Boys
1 2:44.95 11-12 200 Individual Medley 2:48.30 2
3 5:45.99 13-14 400 Individual Medley 5:34.99 4
5 5:32.70 15-21 400 Individual Medley 4:59.99 6
7 2:22.97 11-12 200 Free 2:26.51 8
9 6:11.68 13-14 500 Free 5:38.90 10
11 6:04.99 15-21 500 Free 5:37.01 12
Saturday AM Prelims
Girls Qualifying Time Event Qualifying Time Boys
13 1 entry per team 11-12 200 Free Relay-Timed Final 1 entry per team 14
15 1 entry per team 13-14 200 Free Relay-Timed Final 1 entry per team 16
17 1 entry per team 15-21 200 Free Relay-Timed Final 1 entry per team 18
19 2:12.70 13-14 200 Free 2:08.40 20
21 2:12.46 15-21 200 Free 1:58.99 22
23 1:26.10 11-12 100 Breast 1:31.05 24
25 2:59.99 13-14 200 Breast – Timed Final 2:49.50 26
27 2:58.99 15-21 200 Breast – Timed Final 2:41.50 28
29 34.70 11-12 50 Back 35.68 30
31 1:10.01 13-14 100 Back 1:08.10 32
33 1:07.05 15-21 100 Back 1:02.50 34
35 1:20.50 11-12 100 Fly 1:20.52 36
37 1:10.10 13-14 100 Fly 1:06.90 38
39 1:09.50 15-21 100 Fly 1:03.98 40
41 28.93 11-12 50 Free 29.35 42
43 27.44 13-14 50 Free 26.25 44
45 27.05 15-21 50 Free 23.70 46
47 1 entry per team 13-14 400 Medley Relay-Timed Final 1 entry per team 48
49 1 entry per team 15-21 400 Medley Relay-Timed Final 1 entry per team 50
51 22:50.9914:14.00 13-14 1650 Free – Timed Final13-14 1000 Free – Timed Final
22:05.0013:45.00 52
53 22:07.0113:54.04 15-21 1650 Free – Timed Final15-21 1000 Free – Timed Final
21:47.0112:30.00 54
Saturday PM Timed Finals
Girls Qualifying Time Event Qualifying Time Boys
101 1:37.42 9-10 100 Breast 1:42.80 102
103 21.50 8&U 25 Back 21.99 104
105 38.65 9-10 50 Back 39.48 106
107 21.11 8&U 25 Fly 20.95 108
109 1:44.69 9-10 100 Fly 1:45.50 110
111 40.65 8&U 50 Free 41.55 112
113 32.78 9-10 50 Free 33.39 114
115 1 entry per team 8&U 100 Free Relay 1 entry per team 116
117 1 entry per team 9-10 100 Free Relay 1 entry per team 118
Saturday Evening Finals
Girls Qualifying Time Event Qualifying Time Boys
19 Top 16 Prelims 13-14 200 Free Top 16 Prelims 20
21 Top 16 Prelims 15-21 200 Free Top 16 Prelims 22
23 Top 16 Prelims 11-12 100 Breast Top 16 Prelims 24
29 Top 16 Prelims 11-12 50 Back Top 16 Prelims 30
31 Top 16 Prelims 13-14 100 Back Top 16 Prelims 32
33 Top 16 Prelims 15-21 100 Back Top 16 Prelims 34
35 Top 16 Prelims 11-12 100 Fly Top 16 Prelims 36
37 Top 16 Prelims 13-14 100 Fly Top 16 Prelims 38
39 Top 16 Prelims 15-21 100 Fly Top 16 Prelims 40
41 Top 16 Prelims 11-12 50 Free Top 16 Prelims 42
43 Top 16 Prelims 13-14 50 Free Top 16 Prelims 44
45 Top 16 Prelims 15-21 50 Free Top 16 Prelims 46
Sunday AM Prelims
Girls Qualifying Time Event Qualifying Time Boys
55 1 entry per team 11-12 200 Medley Relay-Timed Final 1 entry per team 56
57 1 entry per team 13-14 200 Medley Relay-Timed Final 1 entry per team 58
59 1 entry per team 15-21 200 Medley Relay-Timed Final 1 entry per team 60
61 1:04.50 11-12 100 Free 1:05.90 62
63 1:00.87 13-14 100 Free 56.99 64
65 59.01 15-21 100 Free 51.99 66
67 38.19 11-12 50 Breast 39.41 68
69 1:20.95 13-14 100 Breast 1:16.99 70
71 1:21.50 15-21 100 Breast 1:09.50 72
73 1:16.04 11-12 100 Back 1:17.36 74
75 2:38.05 13-14 200 Back – Timed Final 2:32.85 76
77 2:34.50 15-21 200 Back – Timed Final 2:25.01 78
79 2:31.05 13-14 200 IM 2:25.50 80
81 2:29.25 15-21 200 IM 2:16.39 82
83 32.97 11-12 50 Fly 34.10 84
85 2:50.95 13-14 200 Fly – Timed Final 2:40.95 86
87 2:58.99 15-21 200 Fly – Timed Final 2:20.99 88
89 1 entry per team 13-14 400 Free Relay-Timed Final 1 entry per team 90
91 1 entry per team 15-21 400 Free Relay-Timed Final 1 entry per team 92
93 22:50.99 13-14 1650 Free – Timed Final 22:05.00 94
95 22:07.01 15-21 1650 Free – Timed Final 21:47.01 96
Sunday PM Timed Finals
Girls Qualifying Time Event Qualifying Time Boys
119 38.60 9-10 50 Fly 39.34 120
121 1:49.49 8&U 100 IM 1:56.47 122
123 1:24.61 9-10 100 IM 1:29.35 124
125 17.35 8&U 25 Free 17.75 126
127 1:15.01 9-10 100 Free 1:16.65 128
129 24.77 8&U 25 Breast 25.05 130
131 44.05 9-10 50 Breast 45.80 132
133 1:25.99 9-10 100 Back 1:27.92 134
135 1 entry per team 8&U 100 Medley Relay 1 entry per team 136
135 1 entry per team 9-10 200 Medley Relay 1 entry per team 136
Sunday PM Finals
Girls Qualifying Time Event Qualifying Time Boys
61 1:03.27 11-12 100 Free 1:05.00 62
63 1:00.01 13-14 100 Free 56.12 64
65 58.23 15-21 100 Free 51.34 66
67 38.29 11-12 50 Breast 38.69 68
69 1:19.99 13-14 100 Breast 1:16.82 70
71 1:21.24 15-21 100 Breast 1:09.04 72
73 1:06.68 11-12 100 Back 1:02.64 74
79 2:30.81 13-14 200 IM 2:25.38 80
81 2:28.48 15-21 200 IM 2:16.31 82
83 32.36 11-12 50 Fly 33.75 84
Heartland Area YMCA Championships
March 17th - 19th, 2017 Chuck Fruit Aquatic
Center, Edwardsville, Illinois
Complete this form and mail with your entry file and fees with check made payable to EDWY Swim
Team to:
EDWY Breakers
17 Junction Dr #235
Glen Carbon, IL 62034
Summary of Fees:
# Individual Entries ______ x $7.00 = ________
# Relay Entries ______ x $21.00 = ________
# Swimmers ______ x $10.00 = ________
Total: ________
Name of Team: ______________________________ Code: ________
Head Coach: ______________________________ Phone: ________________
Email Contact: _________________________________________________
Certified Coaches Attending the Meet:
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
In consideration of this entry and its acceptance, I intending to be legally bound, hereby cosign, waive and release
any and all rights and claims for damages which may occur against the Heartland Area Swim Committee,
Edwardsville YMCA, District 7 School District, Chuck Fruit Aquatic Center Facility, and their representatives,
employees, volunteers, or successors for any and all injuries suffered by me or any contestants or spectators or
representatives in said meet, as a representative of my club and/or association.
__________________________________________ ___________________
Executive Director Date
__________________________________________ ___________________
Head Coach Date
Heartland Area Swimming Championships
Officials for Area Championships 2017
Each team is required to supply Certified Officials for the Area Swim Championships. This
completed form is part of your team’s entry process. Without this form, your team is NOT
CONSIDERED ENTERED into the Area Championships and you are subject to the $100 late fee for
the Area Meet.
Officials needed by each team:
Team: _____________________________________________________________________
Officials’ Names Certification
Level 1 or 2
Available Saturday? Available Sunday?
1.
2.
3.
4.
5.
6.
7.
8.
9.
Thank you.
Please return this form to:
John E Lynch, Jr.
12 Joan Dr.
New Baden, IL 62265 618-792-
4222 (cell).
E-mail: [email protected]
This form must be received by Wednesday March 8th, 2017 at 8pm.
Email Submissions are preferred.
YMCA Sanctioned Championship Meet
Declaration Form
Meet Name: ____________________________________________________________________
Meet Date(s): ____________________________________________________________________
Meet Location: ____________________________________________________________________
Participating YMCA: _________________________________________________________________
YMCA Address: ____________________________________________________________________
Head Coach: ____________________________________________________________________
Coaches Attending: ___________________________________________________________________
Meet Referee: ____________________________________________________________________
Entry Contact Name: _________________________________________________________________
E-Mail Address: ___________________________________________________________________
Phone: ___________________________________________________________________
I attest that all swimmers representing the YMCA above are full privilege members of the YMCA. I
also attest that all coaches representing the YMCA above hold current certifications in CPR, First Aid,
Coaches Safety Training and Principles of YMCA Competitive Swimming and Diving.
_____________________________________ ______________________________
Name of Head Coach Signature of Head Coach
_____________________________________ ______________________________
Name of YMCA Director or Designee Signature of Director or Designee
Please turn this form in with your fees.