Jungle Cat Water Polo Summer 2009 Registration Form


Name: ___________________________________

School for 2009-2010: ___________________________________

Grade for 2009-2010: 7 - 8 - 9 - 10 - 11 - 12 - 13

Group: Cubs - Leopards - Lions

e-mail (please print!): ___________________________________

Home phone number: ___________________________________

Cell phone number: ___________________________________

Emergency phone number: ___________________________________

Position (see the positions page): 2M - 2MD - U - D - G

T-shirt size: S - M - L - XL - XXL

We plan to order team suits this summer, at an additional cost of about $30. Payment will be collected separately at a later date. If you want to order a suit, please circle the size below.

Suit size (optional): 24 - 26 - 28 - 30 - 32 - 34 - 36


Parents:

1. My son or daughter is registered with USA Water Polo through July 31, 2009.
2. Enclosed is a check for $250 made payable to Paul Baudendistel.
3. I understand that playing club water polo does not guarantee that my son or daughter will make his or her high school team.
4. I recognize that it is my responsilbility to communicate to the coaches any medical conditions unique to my son or daughter.
5. I authorize the coaches of Jungle Cat Water Polo to act for me in any emergency, according to their best judgment. I will hold harmless and release the coaches and the club from any and all liability or responsibility for damages related to injuries or death of my son or daughter.

Parent signature: ___________________________________ Date: _______________


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