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Child's Name*

First Last

Child's Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Current School*

How did you hear about us?*

Parent/Guardian Name*

First Last

Email*

Phone*

My child is comfortable swimming in deep water while unassisted*

Yes

Describe your child's swimming experience*

Child's Allergies/Health Conditions (as needed)

Notice of Warning: 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 area, chlorine leaks, ball injuries and personal body contact injuries, etc. By signing this document, I agree to and will abide to all the Shadow WPC policies. If I am a parent/Guardian of a minor I provide consent for my minor child to participate with Shadow Water Polo Club.

I have read and provide consent*

Yes

Date of Consent (D/M/Y): 30/12/2024

Parent/Guardian Providing Authorization*

First Last

*By placing your name in this box, you confirm that you are the individual signing this form, that you confirm that the information provided is correct and that you agree with the statements.

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