Tuesday, June 11 - Thursday, July 18, 2024

Cal Republic WPC

Registration

Step 1 of 4

Summer Splashball Program - Ages 5-14

Biographical
Waiver
Fees
Payment
Payment
Receipt

* Starred fields are required

First Name *

Preferred (Nickname)

Last Name *

Create Password

Sex *

Female Male

Birth Date *

Graduation Month/Year *

Phones

Home *

Cell *

Texting Cell

Mobile provider

Email *

Country *

Street *

Street 2

City *

State *

ZIP Code *

USWP Number

Exp. Date

(12/31/yyyy) USA Water Polo information/Sign-up

USWP Club Name

Left/Right-handed?

Left Right Both

Parent/Guardian

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *