Pride Water Polo Academy - Online Registration

Welcome to Pride Water Polo!

To join our team, please follow these instructions:

1) If you are not currently a member of USA Water Polo please fill out the forms at this link before continuing: USA Water Polo Registration

2) To finalize your registration, please complete this online registration form. You will be asked to provide a credit card for payment. Please note that this online entry system helps Pride Water Polo Academy expedite new member and renewing member registrations. It provides members a way to easily update their information in our data base. This is a secure system so there is no risk to you.

Thank you and welcome to Pride Water Polo Academy!!!

Communication:
Emails are one of our primary methods of communication.
Please input all pertinent email addresses, including athlete email.
Click on the tool below for "Add another email address", and please use the "label".

* Starred fields are required

First Name *

Preferred (Nickname)

Last Name *

Create Password

Sex *

Female Male

Birth Date *

School *

Graduation Month/Year *

Cell Phone *

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

Left/Right-handed?

Left Right Both

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *

Medical Insurance Carrier: •

Medical Insurance #: •

Physician’s Name: •

Physician’s Phone: •

Allergies: •

Additional Notes on Medical History (please list below): •