2019 Southern Utah Water Polo Spring Season Registration
All practices held at the Washington City Community Center pool.
Senior team (Ages: 13-18): Monday-Thursdays 6:30-8:30pm
Junior team(Ages: 8-12): Monday and Wednesday 6:30-8:00pm
Season fee includes; practices, local games ( select Tuesday or Friday) team shirt and picture. Season fees due March 1.
Tournament fees will be an additional fee per tournament. Tournaments will be scheduled throughout the season on Fridays/Saturdays and may require out of the area travel.
A final schedule will be available February 11th.
Last/First Name (Athlete) *
Your answer
USA WATER POLO MEMBERSHIP NUMBER (6 digit #) *
For insurances purposes all participants must have a current membership through USA Water Polo. Participant membership must be affiliated with Southern Utah Water Polo. Having an invalid membership number or club affiliation will prevent athlete form participating in practices or tournaments organized by Southern Utah Water Polo. Enter USA Water Polo membership number.
Your answer
Athlete is registering for: *
Athletes Grade in School *
Fall 2018
High School Athlete Attends (or will attend) *
Primary Contact Name *
Your answer
Primary Contact - Relationship to Athelte *
Primary Contact Phone Number *
(xxx-xxx-xxxx) include area code
Your answer
Primary Contact Email *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Athlete Email or Phone# (Optional)
Your answer
Athlete T-shirt size - included with paid registration. *
Required
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, and Authorization
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 FEES: Junior Team (Ages 8-12):$160.00 Senior Team (Ages 13-18) $225.00. Due by March 1, 2019. Fees are paid to SUWP by PayPal, check or cash. *
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