Winter Athlete Registration

Athlete Name

School Attending

Birthday

Address

Zip Code

Home Phone

Athlete Cell Phone

Father

Fathers Cell Phone

Mother

Mothers Cell Phone

Athletes Email Address

Parents Email

Past Waterpolo Level

Experience

USA Waterpolo Number

USA Waterpolo Expiration date

Primary Contact

Primary Contact Relationship

Primary Contact Phone

Secondary Contact

Secondary Contact Relationship

Secondary Contact Phone

Any health Issues?

Date