2019 Eagle Water Polo Registration
Player's Last Name *
Your answer
Player's First Name *
Your answer
T-Shirt Size *
Gender *
Birthdate *
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Spring and Summer Plans
Grade Level (Fall 2019) *
Name of School player is attending Fall 2019 in Gwinnett County , for example Collins Hill High School *
Your answer
Player's Cell Phone Number *
Your answer
Player's Email Address *
Your answer
Parent's Name(s) *
Your answer
Home Address *
Your answer
Parent Email Address #1 *
Your answer
Parent Email Address #2
Your answer
Additional Email Address
Your answer
Parent's Cell Phone Number #1 (Mom) *
Your answer
Parent's Cell Phone Number #2 (Dad) *
Your answer
Name on Insurance Card *
Your answer
Insurance Company *
Your answer
Group Number *
Your answer
American Water Polo Membership Number *
Your answer
American Water Polo Expiration Date *
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Any medical conditions that may affect the participant's safety, health, stamina, or performance while participating in the sport of water polo?
If yes, please explain...
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Our team's success depends on parent workers at every game. Each family is expected to work as needed during the course of the season (4-5 meets approximately). We understand that some parents are not available and we are offering a buy out option this year for $200, which is due at the Fall Registration. *
Required
How can you get involved with Eagle Water Polo Club? We always need help with our team events; however the following will not fulfill your volunteer duties with our team. However, it is A GREAT way to meet water polo family. *
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