Lynchburg YMCA Swim Team 2025-2026 Registration

Lynchburg YMCA Swim Team

2025-2026 Registration Form

FOR NEW & RETURNING SWIMMERS

Hello and welcome to LY Swimming! Please fill out the forms below to register for our team for the 2025-2026 season. If you have questions, please e-mail Abby at abbywoodruff@ymcacva.org

New Swimmers: Parents will receive swimmers’ group assignments via e-mail after a registration is received. We recommend that you sign up for an evaluation here prior to registering.

If you are registering multiple swimmers, we must ask that you fill out this form for each swimmer separately.

STEP 1: Your swimmer's information

Swimmer's full legal name*

First NameMiddle NameLast Name

Preferred Name

Billy, Suzie, etc.

Birth Date*

Date

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Swimmer's e-mail

example@example.com

School & School District

If in high school, graduation year:

T-shirt size*

High School Team (if applicable)

Summer League (LAL) Team (if applicable)

If an LY swimmer or family referred you to us, please list their name here:

STEP 2: Parent/Guardian Information

Parent/Guardian 1*

First NameLast Name

Parent/Guardian 1 email:*

example@example.com

Parent/Guardian 1 primary phone:*

Please enter a valid phone number.

Parent/Guardian 1 mobile or other phone:*

Please enter a valid phone number.

Parent/Guardian 1 relationship to swimmer:*

Parent/Guardian 2

First NameLast Name

Parent/Guardian 2 email:

example@example.com

Parent/Guardian 2 primary phone:

Please enter a valid phone number.

Parent/Guardian 2 secondary or other phone:

Please enter a valid phone number.

Parent/Guardian 2 relationship to swimmer:

STEP 3: Insurance & Emergency Information

I parent name* hereby give my permission for any and all medical attention necessary to be administered to my child, child's name* in the event of an accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be contacted. This release is in effect for 18 months from the date given below. I also hereby assume the responsibility for the payment of any such treatment.

Insurance Company & Policy Number:

In case I cannot be reached, I hereby designate the following persons to act on my behalf:

· All coaches employed by the YMCA of Central Virginia to act on my behalf, AND:

Other adult or relative:*

Alternate Emergency Contact

Phone number:*

Alternate Emergency Contact Phone Number

Family Physician:

Family Physician Phone Number:

Any known allergies for the swimmer:*

Is there any other medical information for this swimmer that we should be aware of?*

Parent/Guardian Signature*

STEP 4: Please READ ALL LY Policies

Financial

1. Team Registration Fee: $50.00 annually, billed in September or when swimmer joins the program. Registration includes a swim cap, 3 LY t-shirts and an LY car magnet.

2. YMCA membership: $32 per month for a youth individual or $82 per month for family.

All swim team members must be members of the YMCA of Central Virginia
YMCA membership prices are subject to change by the YMCA of Central Virginia independent of swim team management.
Swimmers/families must initiate membership by registering in person at the Jamerson YMCA or Downtown YMCA before beginning practice.

3. Monthly Dues

Dues are drafted to the account on file with the YMCA on or after the same day as YMCA dues (typically the 1st or 15th of the month).
Alternate monthly date and drafting instructions may be arranged with Abby Woodruff if necessary.
Monthly dues by group:
- National $125.00/mo
- Varsity $105.00/mo
- Gold $95.00/mo
- Silver $80.00/mo
- Bronze I and Bronze II $65.00/mo
Monthly dues will not be pro-rated for a partial month if a swimmer decides to discontinue swimming. Any partially completed month where a swimmer attended practices or has already been billed will remain billed in full.

4.USA Swimming Membership All LY swimmers must be registered with USA Swimming, but swimmers will register directly through USA Swimming, NOT through LY.

Registration through USA Swimming will open in September 2025. We will send you a link to register at that time.
Swimmers need to register in the "Premium athlete" category.
Cost will be $88.00 for the period September 202-December 2026.

5. Swim meet entry fees will be billed shortly after the completion of all meets
Entry fees for each meet will be listed in the meet information, and typically include a per-swimmer fee, a facility fee, and a per-event fee.

Each swimmer will be charged a $12.00 team fee for meets held at venues other than the Jamerson Y to cover coaching costs. For meets at the Jamerson Y, this fee will be $2.00.

6. Annual Fundraising Requirement (AFR)

Each family (regardless of the number of swimmers) will be required to raise $250.00 in the 2025-2026 season (September to May).
There will be various opportunities for swimmers to raise these funds. A list can be found under the “Parents” tab at lyswimming.org
If a swimmer leaves the team before October 31 2024, a $100.00 fundraising requirement will be billed.
Any swimmer who remains on the team as of November 1, 2025 will be responsible for the full $250.00 amount.
The balance of unraised money will be billed to the account on file with the YMCA during the time period of January to May 2026. Swimmers who leave the team prior to that time may be billed when they discontinue.

7. Team Apparel

Swimmers who wish to wear a cap at practice or meets are required to wear an LY team cap. Swimmer will be given a cap at the beginning of the season and extras will be available from coaches at practices and meets. The swimmer’s account will be billed for these items when they are distributed. Latex caps cost $5.00 and silicone caps cost $12.00.
On occasion, other team apparel items (t-shirts etc.) will be available for purchase. These items will be billed to your account when delivered.

IT IS THE POLICY OF THE YMCA TO PROVIDE SERVICES FOR ANYONE WHO DESIRES THEM REGARDLESS OF ABILITY TO PAY. INDIVIDUALS INTERESTED IN FINANCIAL ASSISTANCE SHOULD COMPLETE THE NECESSARY APPLICATION FORM AVAILABLE AT THE FRONT DESK.

PARENT/GUARDIAN FINANCIAL RESPONSIBILITY STATEMENT

WE UNDERSTAND THAT SWIM FEES ARE PAYABLE IN FULL FOR THE ENTIRE 9 MONTH SHORT COURSE SEASON (AUGUST THRU MAY) IF A SWIMMER WITHDRAWS FROM THE PROGRAM AFTER OCTOBER 31, 2025, UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE THROUGH ABBY WOODRUFF. WE FURTHER UNDERSTAND THAT MONTHLY DUES WILL BE DRAFTED VIA ELECTRONIC FUNDS TRANSFER (OR CREDIT CARD INSTITUTION) DRAWN BY THE YMCA OF CENTRAL VIRGINIA ON MY ACCOUNT FOR PROGRAM PAYMENTS.

We further understand that there is an Annual Fundraising Requirement of $250 per family. We may participate in fundraising activities sanctioned by the team and credit such proceeds toward our personal fundraising obligation. In the event that such proceeds do not equal our obligation; we understand that the balance we owe will be drafted from our account by May 2026 at the latest.

Parent/Guardian Signature*

CODE OF CONDUCT

I understand that it is a privilege to represent the Lynchburg Y Swim Team and the YMCA of Central Virginia. Therefore, I agree at all times to conduct myself appropriately and honorably, both at the YMCA and while attending functions away from the Y.

As a member of the Lynchburg Y Swim Team,

• I agree to conduct myself in a mature, courteous, responsible and exemplary manner.
• I recognize that the reputation of the Y is affected by and dependent upon my conduct and behavior.
• I promise to adhere to the following rule and regulations:

1. All Swimmers must be Y members in good standing.
2. Proper behavior on the deck and in the locker rooms is expected and a failure to behave appropriately could result in suspension of privileges. Parents of swimmers are expected to supervise and monitor locker rooms as needed.
3. All swimmers must be current in payment of LY Swim Team fees.
4. All swimmers and parents will display proper respect and sportsmanship toward coaches, teammates, officials, fellow competitors, and the public.

• I further acknowledge that the following conduct is unacceptable and will NOT be tolerated:

1. Possession or use of alcohol, tobacco, vaping products/devices or any illegal or banned substances.
2. Illegal or inappropriate behavior, including aggressive or sexually directed behavior and any type of bullying, that would impact others negatively, detract from a positive image of the team or be detrimental to its performance objectives.

• All communications between a coach or other adult and an athlete must be professional in nature and for the purpose of communicating information about team activities. The content and intent of all electronic communications must adhere to the USA Swimming Code of Conduct regarding Athlete Protection.
• I understand that failure to abide by the LY Swim Team CODE OF CONDUCT may result in immediate disciplinary action including, but not limited to, the following:

1. Suspension from the event, practice or meet, with the family bearing the cost of an athlete’s travel expenses.
2. Suspension or dismissal from the team.
Any appeal may be made by appointment to the Head Coach.

I PLEDGE TO ABIDE BY THE LYNCHBURG YMCA SWIM TEAM CODE OF CONDUCT.

Initial*

BULLYING:

Bullying is aggressive behavior that is intentional, is repeated over time, and involves an imbalance of power or strength. Bullying can take on various forms, including:

1. Physical bullying-when one person engages in physical force against another person, such as by hitting, punching, pushing, kicking, pinching, or restraining another.

2. Verbal bullying-when someone uses their words to hurt another, such as by belittling or calling other hurtful names.

3. Nonverbal or relational bullying - when one person manipulates a relationship or desired relationship to harm another person. This includes social exclusion, friendship, manipulation, or gossip. This type of bullying also includes intimidating another person by using gestures.

4. Cyberbullying -the intentional and over act of aggression toward another person by way of technological tool, such as email, instant messages, text messages, digital pictures or images, or website postings (including blogs).

Cyber bullying can involve:

· Sending mean, vulgar, or threatening messages or images.

· Posting sensitive, private information about another person.

· Pretending to be someone else in order to make that person look bad.

· Intentionally excluding someone from an online group.

· Hazing- an activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers that person regardless of that person's willingness to participate.

· Sexualized bullying -when bullying involves behaviors that are sexual in nature. Examples of sexualized bullying behaviors include sexting, bullying, that involves exposures of private body parts, and verbal bullying involving sexualized language or innuendos.

Anyone who sees an act of bullying, and who then encourages it, is engaging in bullying. This policy applies to all children/youth, Staff and Volunteers.

Initial:*

Waiver and Release of Liability

Express assumption of risk:

I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include but are not limited to falls which can result in serious injury or death, injury, or death due to negligence on the part of myself, my training partner, or other people around me, injury, or death due to improper use or failure of equipment. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or program including but not limited to CrossFit, Regymen, Better You Bootcamp, Recovery, Personal Training, Swim Lessons, Youth Sports, and Swim Team. Each program may have contra-indications.

I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

Release: In consideration of the above-mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities available at the YMCA of Central Virginia (CVA), I, the undersigned hereby release the YMCA of Central Virginia, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the YMCA of CVA, their principals, agents, employees, and volunteers. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with to administer first aid YMCA of CVA deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well-being of the child.

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by YMCA of CVA. Therefore, the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless The YMCA of CVA, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by YMCA of CVA.

Photo/Video Release: I hereby grant YMCA of CVA permission to use my photograph/video image in any and all publications for the YMCA of Central Virginia or Jamerson CrossFit, including web site entries, without payment or any other consideration in perpetuity. I hereby authorize the YMCA of CVA to distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge YMCA of CV from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have by reason of this authorization.

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Parent/Guardian Name:*

First NameLast Name

Parent/Guardian e-mail:*

example@example.com

Today's Date*

Date

Parent/Guardian Signature*

Swimmer Signature (if 18 years old or older)