East Bay RHINOS Fall 2019 Application
Girls Team: September 5, 12, and 19 from 7:30-9:00pm
Boys Team: October 10, 17, and 24 from 7:30-9:00pm
Mini Tournament (tentative): Saturday November 2nd 3-6pm (group dinner afterwards at Los Pericos)
Please submit this form along with your donation (paypal to
or check to "Bay Area Kayak Polo"). For scholarships, fill out the application here:
Thank you and see you on the water!
Which season? (girls can choose both)
Girls: September 5, 12, 17 plus Nov 2nd tournament
Coed: Oct 10, 17, 24 plus Nov 2nd tournament
Both Girls team and Co-ed team (add $45 to the fee below)
Cell Phone #
Can we add this phone number to a group text message service called Remind?
Fees: Please select which option best suits your needs and send via paypal to
, or bring cash/check to first session
$60 - this covers the rental of the pool ($15/student/session)
$100 - this covers pool rental plus coaching stipend
$160 - this covers pool rental, coaching, and allows another student with financial need to participate
I will fill out a scholarship application to request financial assistance (we will let you know before the first class if you have been granted a scholarship)
Previous kayak, watersports or athletic experience
Any medical conditions (allergies, medications, previous injuries, etc.)?
Permission for Bay Area Kayak Polo to use photos/video of participant for outreach?
Parent/guardian: By typing parent name below, parent gives consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent. (please type FULL parent/guardian name)
A copy of your responses will be emailed to the address you provided.
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