PAWPC Masters Registration
Email address *
Athlete Name *
Athlete Birthday *
Athlete Email *
Emergency Contact Name *
Emergency Contact Email *
Emergency Contact Phone Number *
Any medical conditions or allergies?
I, the registrant, a minor, assume full responsibility and liability as follows: Recognizing the possibility of physical injury associated with water polo and in consideration for Palo Alto Water Polo Club accepting the registrant for its water polo programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify Palo Alto Water Polo Club, affiliated organizations, their employees and associated personnel, including the owners of the pools and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. *
Palo Alto Water Polo Club feels it desirable to provide club coaches with permission to sign the necessary authorization for emergency treatment if it may be necessary. It is understood that in all cases the officials will attempt to secure the advice of the emergency contact by telephone before using the authorization given by this form. Our permission is hereby given to the coach or representative of Palo Alto Water Polo Club to authorize by his or her signature whatever medical or surgical treatment may be considered necessary or advisable by the physician or nurse in attendance in the event of an accident or medical emergency involving myself while participating in the Palo Alto Water Polo Club program. *
I, the registrant, consent to the use of "The athlete's" image or likeness by Palo Alto Water Polo Club which may include but is not limited to various social media and promotional materials. *
Never submit passwords through Google Forms.
This form was created inside of Palo Alto Water Polo Club. Report Abuse