SUWP WINTER SEASON REGISTRATION 2019/2020
Program details: Age/ability specific water polo fundamentals, conditioning, sportsmanship and game awareness. Athletes will have the opportunity to demonstrate these skills in scrimmages and tournaments.

SEASON DATES: November 4th -January 23rd (no practices during Holiday breaks)
AGES: 8-18: athletes will be divided by age and ability. Independent swimming ability required.
PRACTICE DAYS/TIMES: Monday, Wednesday AND Thursday 6:30-8:00 pm
SEASON FEE: $180.00 includes practices, games(local/away), tournament and Eggbeater Invite Tournament t-shirt
Payable to SUWP cash/check or PayPal (found on registration form below) by first day of practice

All practices are held at the Washington City Recreation Center Pool
All athletes must have a CURRENT USA Water Polo membership (BRONZE) affiliated with Southern Utah Water Polo
Athlete name (LAST/FIRST) *
Your answer
Athlete t-shirt size (adult sizes) *
Athlete USA Water Polo Membership number. *
Your answer
Primary Contact Name (First/Last) *
Your answer
Primary contact e-mail *
Your answer
Primary contact phone number *
Your answer
Eggbeater Tournament Participation ages 8-16 Tournament in Cedar City(age as of tournament date) *
My child has a medical condition that the Coaching Staff needs to be aware of.
Briefly describe medical condition. If requested, Coaches will arrange a meeting to discuss with parent/child prior to the first day of practice.
Your answer
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. In the event of a medical condition or injury which prevents my athletes from fully participating in the activity of water polo I will bring it to the attention of the Head Coach immediately (email or phone call). I understand that a note will be required from a licensed physician clearing my child to resume full participation in practice, scrimmages or tournaments.

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, its Coaches, employees, volunteers, related parties, or other organizations associated with Southern Utah Water Polo and its associated team 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.
As parent or legal guardian of the registered athlete, I have read and accept the Informed Consent, Release Agreement, and Authorization. Type name below: *
Your answer
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