Club Registration

Club Registration

Please register for all sessions through this form. Returning members - please complete the form again if you've had any changes in contact information. This helps to keep our database current! If you have more than 1 child in the program, please register each one seperately. We are not accepting online payments at this time so please continue to pay by check at practice. Let me know if you have any questions.

Jason

GO DESERT SHARKS!

* Required fields
Name *
E-mail Address *
Permanent Address *
Home Phone *
Father's Name *
Father's Cell # *
Mother's Name *
Mother's Cell Phone # *
Athlete's Date of Birth *
Gender *
Do you live less than 50 miles from CSUB? *
I am registering for: *
USWP Insurance # (required) *
USWP Insurance Expiration *
	I AGREE AND UNDERSTAND I understand the risks involved in the sport of water polo, and that participation in the Bakersfield Water Polo Club could result in injury, sickness or death of my child. It is understood that the Bakersfield Water Polo Club does not provide medical insurance covering injuries of any nature. I hereby release Bakersfield Water Polo Club and employees from any and all claims, demands, and causes of actions resulting from participation in the Bakersfield Water Polo Club. *
Family Insurance Company *
Insurance Policy # *
Emergency Contact: Name *
Relationship *
phone number *
	I hereby authorize the coaches of the Bakersfield Water Polo Club to act within their best judgement in case of an emergency requiring medical attention. I certify that I am the parent or legal gaurding whose name and contact information appear on this registration form. *

I have read and agree to the Privacy Policy *

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Please bring a check made payable to BWPC or cash to the first practice or before.