SJX Summer 2024 Aquatics Camps
SJX Summer 2024 Aquatics Camps (Schedule):
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Athlete Last Name *
Athlete First Name *
Gender *
Birthdate *
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Camp you are signing up for (select all that apply): *
Required
School Attended *
Parent Name 1 *
Parent 1 Email *
Parent 1 phone # (xxx-xxx-xxxx) *
Parent 2 Name
Parent 2 Email
Parent 2 phone # (xxx-xxx-xxxx)
Medical Doctor (name, group, phone#)
Dentist (name, group phone #)
Any medical conditions/allergies? (write none if applicable)
I have read "The Team's" parent/player/team contract *
I, the parent/guardian and 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 San Jose Express Aquatics accepting the registrant for its water polo programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify San Jose Express Aquatics, 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. *
Required
Special Covid-19 Waiver - I, the parent/guardian and the registrant, a minor, recognize the possibility of transmission of viral infections including Covid-19 despite practices adhering to regional, state, and federal guidelines of outdoor activities.  I hereby release, discharge and/or otherwise indemnify San Jose Express Aquatics, 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 with regard to viral infections and Covid-19. *
Required
San Jose Express Aquatics feels it desirable to provide club coaches with the parents or guardians’ 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 parent by telephone before using the authorization given by this form. This authorization is similar to that which a number of parents furnish to friends or relatives in whose care their children may be left. Our permission is hereby given to the coach or representative of San Jose Express Aquatics 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 my child while participating in the San Jose Express Aquatics program. *
Required
I, the parent/guardian and the registrant, a minor, consent to the use of "The athlete's" image or likeness by San Jose Express Aquatics which may include but is not limited to various social media and promotional materials. *
Required
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