Waiver/Tryout Form - Vancouver Vipers Water Polo

Participant's Name*

First Last

Participant's Date of Birth*

Gender*

Male
Female
Non-binary

Pronouns (optional)

she/her
he/him
they/their

Allergies/Medical Condition

Primary Email Address*

Alternate Email Address

Name of Parent/Guardian

First Last

Parent/Guardian's Cell Number

Name of Parent/Guardian

First Last

Parent/Guardian's Cell Number

Program (select program athlete would like to try)*

Splashball/9U (2014 & younger)
11U (2012-2013)
13U (2010-2011
15U (2008-2009)
17U (2006-2007)
19U / Masters (2005 & older)

How did you find out about us?*

Acknowledgement*

I certify that the information on this form is correct to the best of my knowledge and that as the parent/guardian of the above named player(s), hereby gives approval to his or her participation in all Water Polo activities. I assume all risk and hazards incidental to such participation and to traveling to and from activities, and I do hereby waive, release, absolve, indemnify the organizers, coaches, managers, referees, assisting or participating parents and persons transporting our son or daughter to or from activities, for any claim arising out or any injury to our son or daughter.

The club reserves the right to change practice times and locations based on pool availability.

This information is required insurance purposes only and will not be shared.

By clicking this box you agree with the following statement:*

I Agree

Agreement to Play

By clicking the box above you agree to the following: I understand that my child is responsible for observing the rules of the club at all times. I agree that my child will participate at his/her own risk. I give permission for my child’s name, phone number and address to be provided to BC Water Polo Association in order to register for insurance coverage.