2021 Eagle Water Polo Registration
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Player's Last Name *
Player's First Name *
T-Shirt Size (for Spring Season..adult sizes only) *
Gender *
Do you need a NEW team suit (It will take 4-6 weeks to come in) *
Suit Size Only If Ordering (leave blank if you are not)
Birthdate *
MM
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DD
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Grade Level (Spring 2021) *
NAME of SCHOOL player is attending in Gwinnett County, for example Collins Hill High School *
Player's Cell Phone Number *
Player's Email Address *
Parent's Name(s) *
Parent Email Address #1 *
Parent Email Address #2
Additional Email Address
Parent's Cell Phone Number #1 (Mom) *
Parent's Cell Phone Number #2 (Dad) *
Home Address *
Name on Insurance Card *
Insurance Company *
Group Number *
American Water Polo Membership Number *
American Water Polo Expiration Date *
MM
/
DD
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YYYY
Any medical conditions that may affect the participant's safety, health, stamina, or performance while participating in the sport of water polo? *
If yes, please explain...
Our team's success depends on parent workers at every game. However, this year, due to COVID-19, we will have a limited amount of workers at each game. Would you be interested or available to work if we needed your help. *
Any additional information (if None ..write GO EAGLES!)
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