CT Premier Water Polo Club - Online Registration

Welcome to CT Premier Water Polo Club Member Registration!

Please create a profile and password for EACH PLAYER you are registering. Use the PLAYER NAME in the primary name fields below. Once you have completed this member registration, you will be able to sign up for practices and tournaments. Looking forward to seeing you at the pool!

* Starred fields are required

First Name *

Preferred (Nickname)

Last Name *

Create Password

Sex *

Female Male

Birth Date *

School *

Graduation Month/Year *

Grade *

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

Left/Right-handed?

Left Right Both

The fields above are for the Athlete/Player name and personal information. •

I have provided Athlete/Player name and personal information above. I will provide parent/guardian information below.

If you do not yet have your USA Water Polo membership number, type into the USWP field above "111111". •

I understand.

Parent #1 Name •

Parent #1 Email •

Parent #1 Phone Number •

Parent #2 Name

Parent #2 Email

Parent #2 Phone Number

6-8 Athlete ID

(Vera add instructions)

Does athlete have any allergies, chronic illness or medical conditions? Please explain or write "none". •

Please describe the medical treatment plan for the above if applicable.

Does the athlete have any prescribed inhalers? Please explain or write "none". •

Medical Release Form •

Medical Release Form

I have printed the Medical Release Form. I will complete it on paper and turn it in to the club administrator.

Photo Release Form •

Photo Release Form

I have printed the Photo Release Form. I will complete it on paper and turn it in to the club administrator.