2022 NJS Coach / Junior Coach Reg form

2022 NJS Coach / Junior Coach Registration form
This is the registration form for COACHES & JUNIOR COACHES (16-17 yr olds), that can be completed & submitted electronically, paying with a credit card or Pay pal.

ALL NEW COACHES MUST BE REGISTERED FIRST - BEFORE YOU WILL BE ABLE TO GET A BACKGROUND CHECK, APT, CAT, FOC 101, FOC 201 & FOC RULES & REGULATIONS.

NEW OR RENEWING COACHES CAN UPLOAD THE FOLLOWING WITH YOUR REGISTRATION : LGT & STSC on line OR CPR STSC in water & STSC on line, and Concussion Training

ONCE A NEW COACH IS REGISTERED YOU WILL BE NOTIFIED BY THE NJ SWIM OFFICE TO COMPLETE YOUR COACHING REQUIREMENTS: BACKGROUND CHECK, ATHLETE PROTECTION TRAINING, COACHES ADVANTAGE TRAINING; EDUCATIONAL REQUIREMENTS: FOUNDATIONS OF COACHING 101 (1ST YEAR), 201 & RULES & REGULATIONS (PRIOR TO 2ND YEAR).

Membership cards will not be printed by the NJ Swim Office this year, please print from your Deck pass.

The application will cover from September 1, 2021 - December 31, 2022

The 2022 fee is $85.00 by check or credit card (no application is processed until a payment is received)
Enter Last Name *
Middle Name (skip if no middle name
Legal First Name *
Preferred / Nick name (skip if none)
Have you ever been a member of USA-Swimming under a different LAST NAME?, If YES please provide that name:
Date of Birth (mm - dd - yyyy *

Month Day Year
Gender *

FEMALE MALE
CLUB CODE
CLUB NAME *
IS THIS A NEW CLUB FOR YOU THIS YEAR (Yes or No) *

NO YES
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
USA CItizen (yes or no) *
RACE & ETHNICITY (you may select up to two choices
Are you a member of another FINA Federation (yes/no) *
If YES to FINA Federation - which one (country)
I AM REGISTERING AS AN: *

COACH JUNIOR COACH (16-17 Yrs of age, no background check until turn 18)
What are the primary age groups you coach (select all that apply) *

10 & Under 11-12 yr olds 13-14 yr olds 15-18 yr olds 19 & older Masters
Would you like to learn more about the USA Swimming Foundation's initiatives

YES NO
Would you like to receive the electronic USA-S Newsletter

YES NO
Y Principles Course (YMCA coaches only) please upload certificate if this is your 1st year as a Y Coach, or you do not have this noted on your Deck Pass card
Y Principles upload your certificate here

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All coaches (except for Junior Coaches) must have a current background check and APT, Athlete Protection Training.

NEW COACHES cannot begin the Background, APT or CAT courses until their membership application has been processed by the LSC (NJ Swimming).

Background check is done every 2 years

APT is done every year

Background check: www.usaswimming.org/backgroundcheck

APT - www.usaswimming.org/apt

If these do not show up on your Deck pass please contact the NJ Swim Office NJSwimOffice@gmail.com
All Coaches & Junior Coaches must have completed a Concussion Protocol Training course on file. In the State of New Jersey you only need take a course once, until notified otherwise. If it shows up on your Deck pass no need to submit again. ALL NEW COACHES MUST SUBMIT HERE

You can take either the CDC or NFHS course and download the certificate below:

Centers of Disease Control: www.cdc.gov/headsup/youthsports/training/index.html>

National Federation of State High School Associations (NFHS) https://nfhslearn.com/
PLEASE UPLOAD YOUR CONCUSSION CERTIFICATE HERE

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USADA COACH'S ADVANTAGE TRAINING

All coaches must complete the online USADA Coach’s Advantage Tutorial annually. The course takes approximately 20 minutes to complete and is offered at no charge. Results are automatically reported into the USA Swimming database upon successful completion.

Current and previous members can access the course at any time. This course is offered at no charge.

New members cannot begin the course until their membership application has been processed by the LSC (NJ Swimming).

This course is renewed annually.
EDUCATION REQUIREMENTS FOR ALL COACHES & JUNIOR COACHES can be found at www.usaswimming.org/FOC

1st Year: Must complete FOC 101 WAS REGISTERED

2nd Year & On: must complete FOC 201 & FOC Rules & Regulations PRIOR to registration

These should be automatically reported to USA Swimming, but if you do not see them completed on your Deck pass please upload below
ALL COACHES & JUNIOR COACHES MUST HAVE EITHER 1) LGT & STSC ON LINE OR 2) CPR, STSC IN WATER & STSC ON LINE CERTIFICATIONS. (STSC - Safety Training for Swim Coaches)

All acceptable courses can be found at https://www.usaswimming.org/coaches/coaching-membership-requirements-checklist/coach-safety-requirements

COACHES MUST STAY CURRENT WITH ALL CERTIFICATIONS

PLEASE UPLOAD YOUR CURRENT CERTIFICATIONS BELOW.
Please upload your LGT or CPR certification

Cancel of
Please upload your Safety Training for Swim Coaches In-Water, skip if you are submitting the LGT CPR AED certification

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Please upload your Safety Training for Swim Coaches On-Line certificate

Cancel of
Please check *

By becoming a member of USA Swimming, I hereby agree to abide by the rules, regulations and Code of Conduct of USA Swimming
Please check *

I acknowledge that when i learn of facts that give reason to suspect that a child has suffered an incident of abuse, including sexual abuse, I must report to the law enforcement within 24 hours pursuant to the Protecting Young Victims from Sexual Abuse and Safe Sport Authorization Act
Please check *

I acknowledge that I have reviews and agree to abide by rules & regulations of the Minor Athlete Abuse Prevention Policy and that i must complete Athlete Protection Training
Signature *

Clear
Date *

Month Day Year
Date
My Products *
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2022 Coach This is for Coach & Junior Coach
$ 85.00

2022 LifeTime Membership USA-S/NJS Lifetime member
$ 1,019.00

Total

$ 0.00
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2022 NJS Coach / Junior Coach Registration form