NBWP High School - Summer 2017 Season Registration
The 2017 High School Summer Season at NBWP is almost here. The season runs from June 6th through September 1st and promises to an AWESOME ONE! With practices 5 days a week, weekday and weekend games/tournaments, travel tournaments and volunteer opportunities, there is no better place to take your game to the next level! Below you will find our online registration form. All participants MUST fill this out! If you do not fill out this form, you will not receive email updates/information and you will not be allowed to participate in games or practices. This form and payment must be received by Friday, June 2nd to avoid possible late charges.

For those of you participating in other sports and/or clubs at the same time; we welcome you! We will work with you to make sure you can participate as much as your schedule allows. Please contact me directly if you have conflicts due to another sport or club commitment.

This season we will be offering...
- 5 water practices a week
- 4 weekly stretching and ball handling practices (the first 30 minutes of each practice Monday-Thursday)
- Chalk talks
- 12+ games
- Masters Tournaments
- Travel Tournaments
- Volunteer Opportunities

The full season schedule can be found online at.... (the game schedule is not finalized yet, but will be coming soon).

http://northbeachwaterpolo.com/high-school/club-schedule/

PAYMENT INFORMATION:

Payment can be submitted online or by check. If anyone would prefer to turn in a paper registration form, please email me directly at claire@northbeachwaterpolo.com to request all the necessary forms.


Summer 2017: June 6th - September 1st (10 weeks)
• The cost for our all inclusive summer program is $460. Registration and payments should be made by Friday, June 2nd. A late fee of $50 dollars MAY be assessed after June 2nd.

*** ALL athletes will ALSO need to register for American Water Polo ($40 annual membership). www.americanwaterpolo.org

Make checks payable to: North Beach Water Polo
Checks can be handed in at practice or payment can be made by credit card at www.northbeachwaterpolo.com

* Required

Athlete First Name
Your answer
Athlete Last Name
Your answer
Graduation Year
Gender
What high school do you attend?
Your answer
What is your American Water Polo ID #?
AWP offers a 12 month membership, make sure to check and see if your membership is still active. If not you will need to visit americanwaterpolo.org and register/re-register before signing up for North Beach Water Polo.
Your answer
What position do you play?
Athlete Email Address
Your answer
Athlete Cell Phone #
Your answer
Parent 1 First Name
Your answer
Parent 1 Last Name
Your answer
Parent 1 Email Address
Your answer
Parent 1 Phone #
Your answer
Parent 2 First Name
Your answer
Parent 2 Last Name
Your answer
Parent 2 Email Address
Your answer
Parent 2 Phone #
Your answer
Home Address
Your answer
Home Phone #
Your answer
Emergency Information / Medical Release
Though we do not expect there to ever be a problem, we must have all of this information just in case. We want to make sure your kids are always safe and protected!
Emergency Contact Name
Your answer
Emergency Contact Phone #
Your answer
Relationship
Your answer
Insurance Company
Your answer
Insurance Company Phone #
Your answer
Group / Policy #
Your answer
ID #
Your answer
Primary Care Physician
Your answer
Hospital / Affiliation
Your answer
Physician's Phone #
Your answer
Medical Conditions
Please indicate ANY medical conditions: allergic reactions, contact lenses, asthma, previous injuries, current medications (and why), etc.
Your answer
Parent / Guardian Consent
Parent / Guardian Consent: *I give my consent/permission to any supervising coach of North Beach Water Polo Club, and the right, on my behalf and in my stand, to arrange for licensed and certified physicians, nurses and/or athletic trainers to render and provide immediate treatment to my child as to injuries that may be sustained by my child while participating in any practices, contests or other activities for North Beach Water Polo, whether directly or indirectly, and whether sustained during practice or in active interscholastic competitions, and without any further or additional authorization by me. My permission and consent also extends to the right of any such supervising coach or North Beach Water Polo personnel to arrange for immediate medical treatment by a licensed or certified physician, nurse, and/or athletic trainer, and for them to apply such emergency medical techniques to my child where, in their judgement, it is deemed appropriate by reason of any injury sustained by my child.
Parent / Guardian Full Name Giving Consent
Your answer
WAIVER AND RELEASE OF ALL CLAIMS FOR PARTICIPATION IN NORTH BEACH WATER POLO, LLC
Name of Participant
Your answer
Please read carefully and be aware that in enrolling and participating in the above program, you will be waiving and releasing all claims for injuries you or the above participant may sustain. As a participant or guardian of a participant in the program, I recognize and acknowledge that there are certain risks of physical injuries, including death, damages or losses which I or the above participant may sustain as a result of his/her participation in any and all activities connected with or associated with such program. I hereby fully release and discharge North Beach Water Polo, LLC, its members, officers, employees and agents, including the North Beach Water Polo Board and any parent volunteers (hereinafter referred to collectively as “Indemnitees”) from any and all claims from injuries, including death, damages or losses which I or the above participant may sustain or which may accrue on account of participation in the program. I do hereby as a parent or guardian or participant specifically release and discharge the Indemnitees from any causes of action I may have as a parent or guardian for support, mental or emotional damage or otherwise arising out of my relationship to the participant. I further agree to indemnify and hold harmless and defend the Indemnitees from any and all claims resulting from injuries, including death, damages and losses sustained by me or the above participant and arising out of, connected with, or in any way associated with the activities of the program. As a participant in this program, I also agree as a condition of my continued participation to act responsibly and adhere to all policies, rules and restrictions established by North Beach Water Polo, LLC and the Illinois High School Association. By signing below I acknowledge that I know, understand, and appreciate the potential dangers associated with my participation in the Program. These hazards may include, but are not limited to, minor scrapes, strains, and bruises, as well as significant injuries such as bodily injury, medical conditions, scrapes, strains, paralysis, eye injury, concussions, fractures, drowning and property loss or damage. If I elect to participate in the Program, I do so voluntarily and totally at my own risk. *
By initialing below, I am stating that I fully understand the nature of the above Program and this Waiver and Release of All Claims. I also acknowledge that I have had the opportunity to consult legal counsel about the terms of this Waiver and Release.
Your answer
Name of Consenting Guardian
Your answer
Comments
As always if you have any comments or questions, please do not hesitate to reach out to me directly by email or phone (listed below). Claire Howie claire@northbeachwaterpolo.com 562-522-0749
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of North Beach Water Polo. Report Abuse - Terms of Service - Additional Terms