2022 Club Application Form

2022 Club Application Form
Registrations of athletes, seasonal athletes, outreach athletes, coaches, and non-athletes are processed by a club's registration officer. The registration officer should process new completed and signed athlete application forms electronically (through Team Manager/Team Unify) within the first 30 days or enters a meet. Any team not sending athlete registrations electronically through 3rd party vender software with a team of 25 plus swimmers will be charged $10 per paper form processed. Outreach documents should be emailed with the electronic file to the CSI office csiswimoffice@swimcolorado.org. All Non-Athlete Registrations can be processed through Jotform.com.

All registrations will be processed and charged to the club through electronic invoicing.
2022 FEES

Year Round:             $500.00 if paid on or before December 1

(UP TO $350 will be refunded if the club sends 1-3 representatives to the 2021 CSI HOD meeting in Thornton, Oct. 3, 2021 and available remotely).

Year Round:             $575.00 if paid after December 1

(UP TO $350 will be refunded if the club sends 1-3 representatives to the 2021 CSI HOD meeting in Thornton, Oct. 3, 2021 and available remotely).

Season 1—April 1-August 28 $120.00

Season 2—August 31-December 31        $40.00 (If registered for Season 1, if not $120.00)

All board members must be a registered non-athlete member of USA Swimming. Also, all clubs must have 2 non-athlete members registered with every club.
If any of the below information changes, please notify your LSC Registration Chair.
Club Code *
Club Name *

Name of Owner/Business/Legal Entity if Different From Club Name:

	Name
1
2
3
4

Club Setting

Rural Suburban Urban
Please Check One: *

NEW CLUB (must have also submitted the new club checklist and items) RENEWING CLUB
Registering for *

YEAR ROUND SEASON 1 (April 1 - August 28th) SEASON 2 (August 29th - Dec 31st)
First Year as a USA Swimming CLUB:
Nearest Major City
Club Web Site
Check Box and Signatures Required

Failure to check these boxes and sign this statement will result in the club application being rejected.
Pre-Employment Screening *

By checking this box and signing below, I formally acknowledge that this club is conducting a pre-employment screening on all new employees who are required to be members of USA Swimming as required in the USA Swimming Rules & Regulations,Article 502.6.8.
By typing my name in this box I am electronically signing this statement *
Date Signed *

Month Day Year
Date
Racing Start Certification *

By checking this box and signing below, I formally acknowledge that this club complies with all Racing Start Certification requirements as stated in the USA Swimming Rules & Regulations, Article 103.2.2 and maintains records for its athlete members
HEAD COACH SIGNATURE - By typing my name in this box I am electronically signing this statement *
Date Signed *

Month Day Year
Date
State Concussion Laws *

By checking this box and signing below (e-signatures are acceptable), I formally acknowledge that this club is following the state concussion laws regarding training coaches and providing educational information to athletes, parents, and guardians as required..
By typing my name in this box I am electronically signing this statement *
Date Signed *

Month Day Year
Date
Minor Athlete Abuse Prevention Policy *

By checking this box and signing below (e-signatures are acceptable), I formally acknowledge that this club is has implemented the USA Swimming Minor Athlete Abuse Prevention Policy, and require all athletes, parents, coaches and other non-athlete members of the club to review and agree to the Policy on an annual basis with such written agreement to be retained by the club.
By typing my name in this box I am electronically signing this statement *
Date Signed *

Month Day Year
Date
Club Personnel
Club Contact/Representative (This person will recieve USA Swimming mailing, CSI infromational emails and be responsible distributing the information.)
Club Contact *

First Name Last Name
Position
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Mobile or main contact # *

Area Code Phone Number
FIND A CLUB Contact (this is the person that will show up on the USA Swimming Website) *

First Name Last Name
FIND A CLUB Phone Number *

Area Code Phone Number
FIND A CLUB Email *
example@example.com
HEAD COACH (must be currently registered and have all certifications) *

First Name Last Name
HEAD COACH Email *
example@example.com
Team President (or Secondary Contact)

First Name Last Name
President Email
example@example.com
Club Registrar (person that will be sending in the swimmer registrations) *

First Name Last Name
Registrar Email *
example@example.com
Team Treasurer/Financial person (this person will receive the invoices) *

First Name Last Name
Treasurer/Financial Email *
example@example.com
The Treasurer Understands that Invoices are sent on the last Monday of the Month and payment is due by the 8th of the following month. *

Yes
Safe Sport Club Representative *

First Name Last Name
Safe Sport Club Representative Email *
example@example.com
PRIMARY ORGANIZATIONAL AFFILIATION, WHO OWNS THE CLUB, CLUB TAX LISTING (To register as a club, a selection must be made for Primary Organizational Affiliation, Who Owns the Club and Club Tax Listing.)
Check here

Check if registered last year and there are no changes to the Primary Organizational Affiliation,Who Owns the Club and Club Tax Listing that were listed last year.
Club's Federal Tax ID Number: *
PRIMARY ORGANIZATIONAL AFFILIATION (Please note the club’s primary relationship/affiliation with any one of the following organizations. Choose one only.)

Not Applicable Boys & Girls Club College/University Country Club Health & Fitness Club Hospital Jewish Community Center Park & Recreation Department Private School Public School/District Summer Club or Home Owner’s Association YMCA YWCA Other
Who Owns the Club

Coach Owned (**MUST PROVIDE OWNER INFO) Boys & Girls Club College/University Country Club Health & Fitness Club Hospital Jewish Community Center Non-Profit Corporation (Parent Board) Park & Recreation Department Private School Public School/District Summer Club or Home Owner’s Association YMCA YWCA Other
Club Tax Listing (Please list the club’s main tax listing and not the parent’s/booster organization if it is a separate entity.)

Sole Proprietor Partnership LLC Sub-S Corporation Other For-Profit Corporation 501(c)3 Non-Profit Corporation Other 501(c) Non-Profit Other Non-Profit Corporation Does Not Apply
Name of Coach Owner

First Name Last Name
Coach Owner's USA SWIMMING ID#
***Bylaw 2.6.6: All employees, including individuals serving on the board, of USA Swimming member clubs must be non-athlete members of USA Swimming.
***CLUB HAS A BOARD OF DIRECTORS OR OTHER GOVERNING BODY RESPONSIBLE FOR DAY-TO-DAYOVERSIGHT OF CLUB OPERATIONS

YES No. If no, please name second coach member in next section

If yes, please list names (first, last) of board and/or governing body of members (all must be non-athlete members in good standing):

	First Name	Last Name	Current USA Swimming Non-athlete Member (Y/N)
Board Member President
Board Member Treasurer
Board Member #3
Board Member #4
Board Member #5
Board Member #6
Board Member #7
Board Member #8

Bylaw 2.6.12: All clubs must have either (i) at least one member coach plus a board of directors or other governing body; or (ii) at least two member coaches to ensure that there are at least two adult authorities at each member club for communication and accountability purposes.
Name of Additional Non-Athlete Coach Member
2nd Coaches' USA Swimming ID#
Bylaw 2.6.6: All adult employees of USA Swimming member clubs must be non-athlete members of USA Swimming.
Names of Additional Adult Non-Coaching Club Staff (List all names of adult staff all must be non-athlete members in good standing including strength/mental coaches):
LEARN TO SWIM
Does the club or coach own and operate a Learn To Swim Program *

YES NO
If Yes, is the club a current Make a Splash Local Partner

YES NO
If No, is the club associated with a Learn to Swim Program

YES NO
FACILITIES USED BY YOUR CLUB – LIST ALL FACILITIES (To register as a club, a facility must be listed.If additional space is needed to list facilities, use a separate sheet of paper and attach to the application.)

If a facility is no longer in use bythe club, list the facility name and the word “Delete” (example: NathanNatatorium – Delete).
Check if the same

Check if registered last year and there are no changes to the facilities that were listed last year.
Facility #1 Name
Facility #1 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pool 1 Length:
Pool 1 Measurement Length

Yards Meters
Pool 1 Width:
Pool 1 Measurement Width

Yards Meters
Pool 1 # of Lanes:
Pool 2 Length:
Pool 2 Measurement Length

Yards Meters
Pool 2 Width:
Pool 2 Measurement Width

Yards Meters
Pool 2 # of Lanes:
Facility #2 Name
Facility #2 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pool 1 Length:
Pool 1 Measurement Length

Yards Meters
Pool 1 Width:
Pool 1 Measurement Width

Yards Meters
Pool 1 # of Lanes:
Pool 2 Length:
Pool 2 Measurement Length

Yards Meters
Pool 2 Width:
Pool 2 Measurement Width

Yards Meters
Pool 2 # of Lanes:
Information for the office
Question about what membership types for athletes you will offer. Select all that apply *

Year Round/Premium Membership Flex Membership (18 & Under only) Season 1 membership (April 1-Aug 28th) Season 2 Membership (Aug 29th - Dec 31st)
Question about what your club is paying for: *

Our club pays for all non-athlete members, and by checking this box, I would like any non-athlete forms that come in to be charged to our club Our club only pays for non-athlete coach members, please charge only coach members to our account Our club does not pay for Non-Athlete Members
I (name) blanks* representative of the above name club, ensures that all COVID restrictions in my local area will be followed. The club has also ensured that all athlete members fill out the COVID waiver of Liabilty.
Should be Empty:

2022 Club Application Form

Check Box and Signatures Required

Club Personnel

PRIMARY ORGANIZATIONAL AFFILIATION, WHO OWNS THE CLUB, CLUB TAX LISTING (To register as a club, a selection must be made for Primary Organizational Affiliation, Who Owns the Club and Club Tax Listing.)

FACILITIES USED BY YOUR CLUB – LIST ALL FACILITIES (To register as a club, a facility must be listed.If additional space is needed to list facilities, use a separate sheet of paper and attach to the application.)

Information for the office