registration

Bring form to practice with a check or send by mail to Greater Philly Water Polo, 320 West 5th St., Bridgeport, PA 19405
 * Greater Philadelphia Registration Form**

Name

Address

Phone Email DOB Shirt Size

Emergency Contact and Phone Medical Issues we should be aware of:

Level Desired: (place check mark next to option-senior level based on ability and attendance-level not guaranteed)

Senior A Senior B

I need to join American Water Polo because I am not yet a member ($40 if college age, $50 if out of college)

Fall Season $100( does not include current AWP registration)

[|American Water Polo]

Dates:

Total Enclosed: $ Checks should be made payable to Greater Philadelphia Water Polo/AWP

By submitting my registration form, I understand that participation in the sport of water polo can be dangerous. Although rare, it may cause injury or even death. I assume these risks and agree to hold harmless the Young Athletes of America organization, its staff and Directors, and any volunteers involved with the Greater Philadelphia Water Polo program for injury, death, or the loss of property due to my involvement.

Signature: Date: