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Try Water Polo For Free
Player Name
(Required)
First
Last
Grade Level for Fall 2025
(Required)
Please select grade level
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
School Attending in Fall 2026
(Required)
Which high school will your child attend?
(Required)
USA Water Polo Membership Number (if you have one)
Program
Program (please select one)
Splashball (Ages 6–12)
10U Coed
12U Coed
14U Boys
16U Boys
16U Girls
18U Boys
18U Girls
Parent/Guardian Full Name
(Required)
First
Last
Parent/Guardian Phone #
(Required)
Parent/Guardian Email
(Required)
If you want a second parent/guardian email to be included in email communications please add email here.
Consent
(Required)
I do hereby give my consent for my child 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 my child 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 child's 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.)
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