INDIVIDUAL ENTRY CERTIFICATION

This form is to be signed by each individual contestant (not the coach).

YMCA Association #: ____________________

YMCA_NAME: _____________________________________

YMCA_ADDRESS: ___________________________________

To: the National YMCA Swimming and Diving Championship Committee

Please enter me in the 2012 YMCA SHORT COURSE CHAMPIONSHIP to be held at the GREENSBORO, NC, . The Events in which I wish to participate are indicated on our Team Entry. SWIMMERS MAY PARTICIPATE IN 4 INDIVIDUAL EVENTS AND 5 RELAYS.

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, GREENSBORO AQUATICS CENTER, their agents, representatives or assigns, and the ATLANTA, GEORGIA for any and all injuries which may be suffered by me at the 2012 YMCA SHORT COURSE CHAMPIONSHIP.

I hereby declare: that I am eligible to represent my YMCA, according to the Rules that Govern Competitive Sport (11/96) and the Rules for the 2012 YMCA SHORT COURSE CHAMPIONSHIP.

that I am an amateur.
that I have not represented a junior college, college or university in formal swimming competition.
that I am a full privilege annual member of my YMCA and have been for 90 days prior to the championship meet.
that I have not represented another YMCA for the previous four months.
that I have represented only my local YMCA in any open competition during the current season. (Note: A swimmer may compete in open competition unattached but may not represent any team or organization other than his or her local YMCA or high school.)
that I understand the USA-S Technical rules will apply with exceptions as listed in the Coaches Handbook and in entry information.
that I am at least 12 years old as of the first day of the meet.
that I have represented my YMCA Branch or Association in formal competitive swimming and diving competition during the current season which began APRIL 2, 2012 thru APRIL 5, 2012. Have participated in three (3) closed YMCA interassociation meets which must have been contested on separate dates plus one closed National YMCA Sanctioned Cluster, District, Satellite, State, Area or Regional YMCA Championship meet. Times to be proved must be achieved before the entry deadline, MARCH 25,2012.

LIST OF SWIMMERS
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