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Primo Polo Aquatics registration form
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Email *
Player's First Name *
Player's Last Name *
Are there any allergies, medications, special needs, or dietary restrictions you would like to make us aware of? *
Required
Any other general information you would like is to know?
Pediatrician name and phone number? *
Insurance Company and Policy Holder name
Parent/Guardian Name *
Parent/Guardian Phone Number *
Emergency Contact (name, relation to child, phone number) *
I hereby grant permission for Primo Aquatics to use video and/or photos of my child submitted on their website and online environment, including, but not limited to Facebook and Instagram. They may also use submitted materials in publications, promotional flyers, or for any other similar purpose to support its mission of supporting Primo Aquatics. (Please type your name to agree)
 *
In the event that my child experiences a severe, life-threatening anaphylactic (allergic) reaction during water polo camp, a trained  BBMAC staff member (lifeguard) may administer the EpiPen emergency treatment, under indirect supervision of the  school nurse /pool manger. In the event the parents/guardian cannot be reached, permission is hereby given for the physician or dentist designated below to provide emergency care for my child should serious illness/injury occur at camp. (Please type your name to agree) *
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