Saanich Water Polo School

(250) 514-9236

ADULT PROGRAM REGISTRATION

Contact Information

Full Name *

Date of birth

Phone *

Email *

Address *

City *

Postal code *

Program Selection (Mavericks / Night League) *

Mavericks

Night League

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication

Emergency Contact (Other Than Guardian)

Name (Emergency Contact) *

Relationship (Emergency Contact) *

Phone (Emergency Contact) *

Email (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 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. *

Waiver Acknowledgment

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