Registration

North Houston Water Polo

Registration

North Houston Water Polo
2012 Spring Registration
To register, please fill out the Registration Form.
Please bring the registration fee to the first practice or mail your check to:
                    North Houston Water Polo Club
                    170 N. Hazelcrest Circle
                    The Woodlands, TX 77382

Make checks payable to "North Houston Water Polo Club"


Program Age Group:	Cost (All Groups) - $295.00
Family Discount	$25 discount for each additional athlete
First Name:
Last Name:
Date of Birth:
Street Address:
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
Cell Phone:
School Attending:
USA Water Polo #:	(if you do not have one, please go to www.usawaterpolo.org to obtain one)
Email Address:
Parent(s) Name:
Emergency Contact Person:
Emergency Persons Phone #:
Medical Insurance Info:
List Medical Conditions & Medications:
Important Disclaimer:	I hereby authorize any person affiliated with North Houston Water Polo, including but not limited to any coach, staff, employee, administrator or officer (collectively “NHWP”) to act according to their judgment in any emergency requiring medical attention. I know of no medical, mental or physical condition that might affect my ability to safely participate in this program other than the ones listed above. I understand the risk of injury from the activities of this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce the risk, the risk of serious injury does exist. I will be responsible for any medical and/or other charges in connection with my attendance at practices, games or tournaments. I hereby agree to save, indemnify and hold harmless NHWP and its sponsors against any and all liability, claims or demands for damages arising from injuries sustained during participation in this program. If submitting on-line, printing your name below constitutes your signature and acceptance of the conditions of this disclaimer.
Athletes Signature & Consent to above Disclaimer: *
Parent Signature & Consent to above Disclaimer: *
	* If athlete is under age 18, a parent's signature is required
	* If submitting on-line, printing your name above constitutes your signature and acceptance of the conditions of the disclaimer.

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