View Ridge Water Polo Sign-Up 2017
Please fill out one form for each player. All sections of this form are required for EACH PLAYER in order to participate! Thank You!
I agree to pay the Water Polo team fee without expectation of a refund. VR members will be billed in August. Nonmember fees are due by August 15, payable by check in the office to VRSTC water polo.
VR Members: Preseason ($30) plus Regular Season ($75)
VR Members: Preseason only ($30)
VR Members: Regular Season only ($75)
Non-Members: Preseason ($30) plus Regular Season ($100)
Non-Members: Preseason only ($30)
Non-Members: Regular Season only ($100)
Player Name (First Last)
Age: How old will you be at midnight on June 14th 2017?
Masters (over 18)
Player Cell #
Summer Swim Club Membership (You can not play VRWP if you belong to any other summer swim club that has a water polo team, including Midlakes)
Parent/Guardian 1 Name
Parent/Guardian 1 Cell #
Parent/Guardian 1 email
Parent/Guardian 2 Name
Parent/Guardian 2 Cell #
Parent/Guardian 2 email
Which High School do you attend, or will you likely attend?
Nathan Hale HS
The Bush School
Chief Sealth HS
Holy Names HS
The Northwest School
The Overlake School
Rainier Beach HS
Seattle World School
South Lake HS
West Seattle HS
Seattle Water Polo League Agreement: Parent/Guardian Agreement Required! I hereby consent to participation by my child to participate in the Seattle Summer Water Polo League. I understand that this activity involves elements of risk of bodily injury, including, but not limited to, activities occurring in a pool and the surrounding environment. We will assume all risks associated with and incidental to participating in the sport of water polo. My child has no special medical conditions, except those described below, and is fit to participate on a water polo team.
Parent/Guardian(s) agree to the above terms
Please List Special Medical Conditions
Medical Release: Parent/Guardian Agreement Required! In consideration of the right and privilege for my child to participate, we hereby release, waive, and agree to hold harmless the Seattle Summer Water Polo League; this club and its members, directors, employees, volunteers; paid and volunteer referees, for any and all liability, claims, legal actions, and demands of any nature whatsoever which may arise from or in connection with the water polo team or related activities. I understand that events may take place away from our club pool. I understand that the coaches are not responsible for transportation to games or related activities. I hereby authorize emergency medical/ dental care and treatment for my child, as necessary.
Parent/guardian(s) agree to the above terms
Concussion Agreement. Both parent/guardian and athlete must read this and agree to the following statement regarding concussions. Any athlete even suspected of suffering a concussion must be removed from the meet or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The new “Zackery Lystedt Law” in Washington now requires the consistent and uniform implementation of long and well-established return to play concussion guidelines that have been recommended for several years: “a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time” and “...may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”. You should also inform your child’s coach if you think that your child may have a concussion. Remember its better to miss one meet or practice than miss the whole season. And when in doubt, the athlete sits out.For current and up-to-date information on concussions you can go to:
athlete and parent or guardian must read and understand this concussion statement BEFORE the athlete can participate in practice or competition. PLEASE CHECK BOTH BOXES IF YOU AGREE.
Athlete has read and agrees to concussion statement
Parent/Guardian(s) has/have read and agrees to concussion statement
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