Register — 222 Water Polo

Registration

2024 Summer Session Registration

Athlete Name

First Name

Last Name

Session Group

Athlete Date of Birth

MM

DD

YYYY

USA Water Polo Number

Expiration Date

MM

DD

YYYY

Athlete Email Address

Athlete Cell Phone Number

(###)

###

####

School

Grade

Parent Emergency Contact

First Name

Last Name

Parent Emergency Contact Phone Number

(###)

###

####

Parent or Other Emergency Contact

First Name

Last Name

Parent or Other Emergency Contact Phone Number

(###)

###

####

Athlete Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Insurance Company

Group Number

Please list any emails you want on the email list

Please separate each email address with a comma