2023 USA Swimming Regional Coach Clinic

Friday, October 6th - Sunday, October 8th

Louisville, Kentucky

Coaches of all levels and experiences are encouraged to sign up for this educational coaching and technique clinic at Genesis Health Clubs Blairwood, hosted by USA Swimming.

Coaches can register individually for $100, or sign-up as a team (2-4 coaches) for $200.

*A confirmation email and link for payment will be delivered within 48 hours of registering*

INDIVIDUAL/HEAD COACH CONTACT INFORMATION

First Name *

Last Name *

USA Swimming Membership ID (if applicable)

Email Address *

Confirm email address- *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Phone *

Team Name *

LSC-

Emergency Contact *

Relationship *

Emergency Contact Phone *

Please indicate your role in this clinic. You may select more than one. *

USA Swimming Coach	YMCA Coach	High School Coach
Other Other

Have you been to a USA Swimming clinic, summit, or camp as a coach? If so, where and when?

What age groups do you have experience in coaching? *

How many years of experience do you have in swim coaching? *

What are you hoping to gain from this clinic? *

MULTIPLE COACH CONTACT INFORMATION

Are you registering for this clinic with 1 or more additional coaches from your team? *

Yes

No

Coach #2- First & Last Name *

Coach #2- Email *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Are you registering for this clinic with 2 or more additional coaches from your team? *

Yes

No

Coach #3- First & Last Name *

Coach #3- Email *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Are you registering for this clinic with 3 or more additional coaches from your team? *

Yes

No

Coach #4- First & Last Name *

Coach #4- Email *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Honor Code *

As a participant in the 2023 Regional Coaches Clinic conducted by United States Swimming, Inc. (“USA Swimming”), I understand and will comply with the following guidelines as set forth by USA Swimming and the Olympic International Operations Committee regulations at all times during the Regional Coaches Clinic. The possession or use controlled substances by any participant participating in the Event is prohibited throughout the duration of the trip (until the clinic has officially disbanded). Curfews established by the staff will be adhered to each day of the camp through departure. Participants will attend all functions including meetings and practices, unless otherwise excused or instructed by a staff member designated by USA Swimming. Participants will refrain from any illegal or inappropriate behavior that would detract from a positive image of USA Swimming and its Clinic participants or be detrimental to its performance objectives. Participants will display proper respect and sportsmanship toward facilitators and event staff. This includes no cell phone / smart phones usage during any presentations etc. Any additional guidelines for the participants in the Clinic will be established as needed by the Director of the Regional Coach Clinic or other person designated by USA Swimming. IMPLEMENTATION: All participants are apprised in writing of this policy. Signature of this document constitutes unconditional agreement to comply with Honor Code of USA Swimming. USA Swimming shall have the right to establish and use one or more systems to determine if all aspects of the policy have been followed by team and staff members. Failure to comply with the Honor Code as set forth in this document may result in disciplinary action under the provisions of the USOPC Policy Manual and USA Swimming Code of Conduct. Such discipline may include, but may not be limited to: Dismissal from the clinic and immediate return home at the participant's expense or at the expense of their guardians.

Authorizations, Waiver, etc.
Check the box to agree.
*

General Acknowledgement & Acceptance - I hereby acknowledge that all information and signatures on this form are applicable to my participation in this USA Swimming activity and I agree to abide by the regulations specified in these documents and in the Rules and Regulations of USA Swimming for the management and conduct of the USA Swimming Program.

Oath of Eligibility- I declare that I am eligible and in good standing with regulations laid down by USA Swimming, the International Federation for Amateur Swimming (FINA), and the International Olympic Committee (IOC). I also declare I am not under suspension or disciplinary action imposed for use of illegal drugs or other athlete regulation infractions. I agree to sign additional documents to this effect when required to do so by USA Swimming or the local organizing committee. I certify that, to the best of my knowledge and belief, I am in good physical condition and have no disease or injury that would impair my performance in this activity and agree that while a participant in this activity, I will keep myself in top physical condition and retain my eligibility status.

Authorization & Event Promotion- I agree to be filmed and photographed by the official photographer(s) and network(s) of USA Swimming under the conditions authorized by USA Swimming and give the event organizers the right to use my name, picture, likeness, and biographical information before, during and after the period of my participation in these activities to promote the activity in which I participate or to promote the success of the team on which I compete. I understand and agree not to use or authorize use of pictures of myself in the uniforms and equipment provided by USA Swimming for the purpose of trade, without the consent of USA Swimming. I agree not to use medals or photos, portraits or film of myself with the medals, which I receive for my performance, for the purpose of trade. Furthermore, it is agreed that I shall return these uniforms and equipment, bearing USA Swimming logos and marks, if and when requested.

Authorization for Medical Services- I hereby give consent for USA Swimming to provide or obtain for me medical care and treatment and emergency medical services for any injuries arising from my participation in this activity. Additionally, I hereby agree that, in the event I elect to obtain any of these services or treatments from any sources other than that provided or obtained by USA Swimming, I shall accept full and complete responsibility. I further authorize release of any medical information necessary to process a claim for accident/medical payment insurance for an injury or illness incurred while I am participating as a member of the USA Swimming delegation in this activity.

Risk of Serious Injury- I understand and appreciate that my participation in the sport of swimming carries a risk of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk.

Waiver & Release- In consideration of allowing me to participate in this activity, I hereby release and hold harmless USA Swimming, members of its board of directors, and its officers, employees, members, volunteers, other participants, and agents (collectively, the "Released Parties"), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and all damage and/or injury, or any type, arising out of my participation in this USA Swimming activity.

Please sign *

clear

A confirmation email with the payment information will be sent to you within 48 hours of registering. Coaches/teams are responsible for the cost of their own lodging.

Questions? Please email Kristin at kalfano@usaswimming.org, or call (719) 309-7198.

8 & under	9-10	11-12
13-18	Collegiate	Professional
None

0-2	2-5	5-10
10-15	15+