2022 NJS Other Non-Athlete Reg form

2022 NJS OTHER Non-Athlete Registration form

Use this form to register as an OTHER (Club Board Member, Chaperone, Meet Director, Meet Manager, Athlete Trainer, Massage Therapist, etc.)
This is the registration form for OTHER NON-ATHLETE MEMBERSHIP that can be completed & submitted electronically, paying with a credit card or Pay pal.

OTHER MEMBERS NEED: Background check, Concussion Training COMPLETED BEFORE YOU CAN REGISTER, Once registered then complete the Athlete Protection Training (APT)

Print out your report from OTS or make a copy of your meet record card/sheet showing your sessions worked during 2021 and enclose it with the other documents, or UPLOAD with this electronic form.

Background check https://www.usaswimming.org/safe-sport/complete-a-background-check RENEW every 2 years

Concussion Protocol Training: CDC or NFHS Once for the State of New Jersey

CDC: https://www.cdc.gov/headsup/youthsports/training/index.html

NFHS: https://nfhslearn.com/

APT: https://www.usaswimming.org/resource-center/athlete-protection-training RENEW every year

If you wish to pay by check please go back to NJswim.org FORMS CENTRAL https://www.teamunify.com/team/eznjslsc/page/forms-central print the OTHER non-athlete form, submit with Concussion Certificate FOR ALL NEW OTHER NON-ATHLETE MEMBERS.

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 (use UN for Unattached, not with any particular club)
CLUB NAME (enter UNattached if not affiliated with any club) *
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)
CERTIFIED OFFICIAL MEMBERSHIP CODE: check all that apply

STARTER STROKE & TURN MEET REFEREE ADMINISTRATIVE
OTHER MEMBERSHIP CODE: check all that apply *

BOARD MEMBER CHAPERONE MEET DIRECTOR MEET MANAGER ATHLETE TRAINER MASSAGE THERAPIST OTHER
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
PLEASE UPLOAD YOUR CONCUSSION CERTIFICATE HERE (For the State of New Jersey you need only do this once until further notice)

Cancel of
PLEASE upload your report from OTS or make a copy of your meet record card/sheet showing your sessions worked during 2021

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
Please select either yearly membership or lifetime membership *
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2022 Other Non-Athlete
$ 85.00

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

Total

$ 0.00
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2022 NJS OTHER Non-Athlete Registration form