Athlete Information and Program Selection

Parent / Guarding Information

Name of an Emergency Contact other than parents

Athlete's Home Address

Do any of  the athletes in the family, submitted on this form have any history of chronic illness or other conditions that coaches need to know about, that may impact their performance or their safety while performing strenuous exercise in a group setting.

Do any of the athletes submitted on this form carry emergency medication for severe allergies, diabetes, or any other condition?

If you selected yes to either of the above, please describe / provide details:

Waiver
I acknowledge and fully understand and agree to assume all risks and hazards involved in and arising out of my child’s activities with Saanich Water Polo School.  I hereby waive, release, forego and relinquish any and all claims, demands, suits, actions or causes of action which I may have against the directors, employees, and organization’s activities. In the event that our family doctor can not be contacted or is unable to attend to my child in an emergency, I hereby authorize and direct Saanich Water Polo School to choose a doctor to attend to my child. I further acknowledge and agree that typing my name on the signature line constitutes an electronic signature. My electronic signature is the legal equivalent of my manual signature.

Participant Name and Program Selection

Participant Contact Information

Address

Name of an Emergency Contact

Please briefly describe your water polo / athletic background, if any

Please let us know if you have a health condition that we need to be aware of (If none please type N/A).

Waiver
I acknowledge and agree to assume all risks and hazards involved and arising out of my involvement in activities with Saanich Water Polo School. I hereby waive, release, forego and relinquish any and all claims, demands, suits, actions which I may have against the directors, employees, and the organization's activities.  I further acknowledge and agree that typing my name on the signature line constitutes an electronic signature, and that my electronic signature is the legal equivalent of my manual signature.