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Water Polo Weight Lifting

Water Polo Weight Lifting is an off-season strength and conditioning clinic for

current and prospective boys' water polo players in grades 8 through 12.

February 4 - February 27, 2019

Mondays and Wednesdays
5:00 - 6:30 p.m.
Canyon Crest Academy Weight Room

$80

How many participants will you be registering? (max 5) *

Camp fee $80 p/p

Participant Information

How many participants are you registering? (max 5) *

First Name *

Last Name *

Birth Date *

Grade *

First Name - 2 *

Last Name - 2 *

Birth Date - 2 *

Grade - 2 *

First Name - 3 *

Last Name - 3 *

Birth Date - 3 *

Grade - 3 *

First Name - 4 *

Last Name - 4 *

Birth Date - 4 *

Grade - 4 *

First Name - 5 *

Last Name - 5 *

Birth Date - 5 *

Grade - 5 *

Current Total:

$0.00

Parent / Guardian Information

Relationship to Participant(s): *

Self

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

City *

State *

Zip *

Phone *

Email Address *

Email Address *

Health Insurance Information

Participant First Name *

List any physical or emotional limitations your child/participant may have: *

None

Allergies

Vision

Heart Murmur

High Blood Pressure

Other or describe any of the above as needed Other or describe any of the above as needed

Participant First Name - 2 *

List any physical or emotional limitations your child/participant may have: *

None

Allergies

Vision

Heart Murmur

High Blood Pressure

Other or describe any of the above as needed Other or describe any of the above as needed

Participant First Name - 3 *

List any physical or emotional limitations your child/participant may have: *

None

Allergies

Vision

Heart Murmur

High Blood Pressure

Other or describe any of the above as needed Other or describe any of the above as needed

Student First Name - 4 *

List any physical or emotional limitations your child/participant may have: *

None

Allergies

Vision

Heart Murmur

High Blood Pressure

Other or describe any of the above as needed Other or describe any of the above as needed

Participant First Name - 5 *

List any physical or emotional limitations your child/participant may have: *

None

Allergies

Vision

Heart Murmur

High Blood Pressure

Other or describe any of the above as needed Other or describe any of the above as needed

By Checking this box I confirm that the participant(s) is/are covered by Health Insurance. Participant must have Health Insurance to participate in this camp. Please provide Insurance Information below. *

I confirm that the participant(s) is/are covered by Health Insurance.

Health Insurance Carrier *

Health Insurance Policy Number *

READ THIS RELEASE AND WAIVER

By clicking on this form you confirm that you have read and agree to all terms in the above release and waiver. *

I agree to the terms in the Release and Waiver