Registration Forms 2009-2010 by Sarahsinthekinchin

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									                                  REGISTRATION FORM

                                          Water Polo Saskatoon, Inc.
                                          Registration Forms 2009-2010


 Athlete s Name

 Birthdate                                                                                   Gender

 Heath Ins. Number

 Email Address(es)

 Guardian Name(s)

 Telephone Number(s) (home)                                  (work)                        e
                                                                                         (cell)

 Mailing Address                                                                         Postal Code
                                                                                          o

 Current School

Please indicate which program(s) you are registering for:

                                               e
                                           Competitive Programs (Full Year)

   Level [Start Date]          Age Requirement               Program Fee         Registration Night    Post-Dated Cheques

   U12 [January 2010]        Born 1998 or later                 $285             $105                  2 x $ 90

   U14 [Sep. 14]             Born 1996 or 1997       $600 + $200 fundraising*    $150                  5 x $ 90

   U16/U18 [Sept. 14]        Born 1992 to 1995       $800 + $200 fundraising*    $150                  5 x $130

   Senior [Sept.8]           Born 1991 or before                $400             $100                  5 x $ 60

   Masters [Sept.8]          Born 1991 or before                $215             $140                  1 x $ 75

        * Please indicate if you are interested in buying out your fundraising obligation:                Yes        No

Additional anticipated costs include Tournament Fees, Travel, Food and Accommodation, which may be anywhere
from $50 to $150 per day per trip. We will always try to keep these costs as low as possible.
                                                      r
                                         Learn-To Water Polo (Term Programs)

        Level [Start Date]              Age Requirement                          Practices                        Program Fee

   U12 LTWP [Sept. 21]                 Born 1998 or later     Monday, 6-7pm, YMCA                                    $125

   U12 LTWP [Sept. 22]                 Born 1998 or later     Tuesday, 6-7pm, Harry Bailey                           $125

   High School League [Sept. 17]       Born 1992 to 1997      Thurs. 5-6pm Harry Bailey** and Sun. PM, Shaw          $150

  Adult Beginner [Sept. 17]            Born 1991 or before    Thurs., 8-9pm Shaw and Sunday evening, Shaw            $150

          ** “High School” Learn-To students may alternatively attend a practice on Monday or Wednesday.
How did you hear about us?
     Leisure Guide     Poster   Sign Board       Friend/Family   Website   Water Polo Saskatchewan
     Survival Guide    Bookmark                  Other: __________________________________

         NOTICE OF WARNING:

There is a potential risk for injury involved in training and participating in the sport of water polo. Water
Polo Saskatoon, Inc., has tried to create a safe and controlled environment for participation. We have
established rules for participation and conduct on and about the playing area that should be followed.
Some hazards which made 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 by all the local, provincial and national policies. If I am a
parent / guardian of a minor, I provide consent for my minor child to participate with Water Polo Saskatoon.

I certify that I :
          Have read and understood the Notice of Warning

          Have read, understand and agree to the Water Polo Saskatchewan PIPEDA Policy

          Have completed the Medical Information Form and Code of Conduct

          Agree to having photographs of myself or my minor taken that could be used for the promotion of
          water polo in advertising posters, fl s, websites, media releases, etc.

          Agree that we may use your contact information to form email or phone lists


Parent / Guardian Signature: ________________________________                  Date: ______________
or
Athlete s Signature: ______________________________________


Office Use Area

                                                      r
                                                    Forms

      Member Registration F
             r             Form                              PIPEDA
                           orm
      Medical Information Fo                                 Code of Conduct

                                   Cheques (payable to Water Polo Saskatoon)
                                                                   a

 Program Fee:
          e

                Registration   October      November     December      January       February      Fundraising

 Amount         $              $            $            $             $             $             $

 Cheque #

								
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