• Athlete

  • Date Format: MM slash DD slash YYYY
  • Parent/Guardian

  • Emergency Information

  • Authorization

  • I hereby consent to and authorize Shadow Water Polo Club and its representative(s) to: share information and provide first aid, and/or obtain medical care and services (e.g., contacting EMS/ambulance) as needed using their best judgement for the health and safety of the athlete during Shadow Water Polo Club activities. 
  • There is a potential risk for injury involved in training and participating in the sport of water polo. The Ontario Water Polo Association Incorporated (OWP) and its member clubs have tried to create a safe and controlled environment for participation. The OWP has established rules for participation and conduct that should be followed. Some hazards which may lead to catastrophic situations are: slips on the pool deck or surrounding areas, chlorine leaks, ball injuries and personal body contact injuries, etc.
  • By placing your name below, you confirm that you are the individual signing this form, you confirm that the information provided in this application is correct, and you agree with the statements.
  • Consent Provided On (D/M/Y): 03/08/2020