Central Florida Sun Registration
Athlete Name *
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Birth Date *
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Address *
Street, City, State, Zip
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Phone *
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Email *
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High School or 14U *
Parent Name *
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Phone *
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Email *
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Emergency Contact Name *
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Phone *
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USWP Athlete # *
*If not registered with USWP, please register online at www.usawaterpolo.com Register for Southeast Zone, Club #17205, Central Florida Sun Water Polo, Bronze membership
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School *
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T-Shirt Size (adult) *
Signature of Parent or Guardian & Date *
By signing (typing name) I understand Water Polo is a strenuous physical activity. Should any medical problem arise or injuries occur, an attempt will be made to notify me by phone. I grant permission to evaluate and treat any minor medical problems. In the event I cannot be reached, I hereby give consent to emergency medical treatment.
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Name of Insurance Co. & Policy # *
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Any medical conditions we should know about *
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