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Masters Registration
Player Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
USA Water Polo Membership Number (if you have one)
Registration Type
(Required)
Monthly Access
Drop In
Masters Monthly Access
Price:
Consent
(Required)
I do hereby give my consent to participate in Devil's Gate Water Polo.
I understand that the coaching staff, the school and the school district are relieved of all responsibility in case the participant is injured while participating at the camp. I understand and acknowledge that some activities, by their very nature, pose the potential risk of serious injury (sprains/strains, fractures, unconsciousness, paralysis, loss of eyesight, etc.) or death to individuals who participate in such activities. I further understand and acknowledge that participation in the camp is completely voluntary. I understand and acknowledge that in order to participate in the camp, I and my child agree to assume liability and responsibility for any and all potential risks which may be associated with participation in such activities. I understand, acknowledge, and agree that the school, the coaching staff, or volunteers shall not be liable for the injury/illness suffered by my child which is incident to and/or associated with preparing for and/or participating in this activity. I acknowledge that I have carefully read this, Parental Consent and Assumption of Risk for Participation Devi's Gate Polo Camp form and that I understand and agree to its terms. I agree to indemnify Devil's Gate Water Polo and the La Canada Unified School District.
Typing my full name below will serve as my e-signature and consent for participation.
(Required)
Consent
(Required)
I agree to the emergency medical treatment.
Should it be necessary for to have medical treatment while participating in this camp, I hereby give the camp personnel permission to use their judgement in obtaining medical services for my child and I give permission to the physician selected by the camp personnel to render medical treatment deemed necessary and appropriate by the physician, I understand that the camp has no insurance covering such medical and hospital costs incurred by my child and therefore any costs for such treatments shall by my sole responsibility.
Typing my full name below will serve as my e-signature and consent to the emergency medical treatment terms.
(Required)
Consent
I agree to photo release.
I consent to have my photo taken and possibly used in marketing, social media, or other promotion materials for the middle school program.
Emergency Contact #1 (Name & Relation)
Phone Number (contact #1)
Emergency Contact #2 (Name & Relation)
Phone Number (contact #2)
Please list anything the staff should know about your student (allergies, medications, personal issues, etc.)
Billing Information
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Billing Address
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