2019 Summer Registration Registration form must be filled our prior to the first day of practice.
Season dates: June 3rd - 28th
Practices are Monday and Wednesday from 7-8pm (ages 8-13) 7-9pm (ages 14-18) -athletes are divided by age and or ability.
Monday - Washington City Community Center
Wednesday - Hurricane City Pool
Friday scrimmages: 7-8pm (ages 8-13) 8-9pm (ages 14-18)
June 7 - Washington City Community Center
June 14 - Hurricane City Pool
June 21 - Washington City Community Center
June 28 - Hurricane City Pool
Season Fee: 60.00 due by first day of practice
Athlete Name *
Your answer
Athlete Age *
Your answer
Athletes Grade in School *
Fall 2019
High School athlete attends or will attend *
Water Polo Club Status *
Choose one
Required
Primary Contact Name(First/Last) *
Your answer
Primary Contact Phone Number *
(xxx-xxx-xxxx) include area code
Your answer
Primary Contact Email *
Your answer
Informed Consent, Release Agreement, and Authorization
I understand that participation in the team sport of water polo involves the risk of personal injury. I also understand that participation in the team sport of water polo is entirely voluntary and requires participants to follow instructions and abide by all applicable rules. In case of an emergency involving my child, I understand that efforts will be made to contact the individual(s) listed as the primary and emergency contacts by the Coach and or medical provider. In the event that these individuals cannot be reached, permission is hereby given to the medical provider to secure proper treatment for my child.

With appreciation of the dangers and risks associated with participating in water polo activities, on my own behalf and behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against Southern Utah Water Polo, their Coaches, employees, volunteers, coordinators, related parties, or other organizations associated with the team sport of water polo and its associated activities.

I also hereby grant Southern Utah Water Polo as well as their authorized representatives, the right and permission to use and publish photographs/film/videotapes/electronic representations and/or sound recordings made while my child is participating in the team sport of water polo and its associated activities. I hereby release Southern Utah Water Polo, their Coaches, employees, volunteers, coordinators, related parties, or other organizations associated with the team sport of water polo and its associated activities from any and all liability from such use and publication and I specifically waive any right to any compensation I may have for any of the foregoing.

Informed Consent, Release Agreement Waiver:
As the parent or legal guardian of the registered participant I have read and understand the informed consent, release agreement and authorization statement above. Type name below.
Authorization accepted by (type name) *
Your answer
Season fee $60.00 payable to Southern Utah Water Polo by PayPal, check or cash. Due by first day of practice. *
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