Orange/Blue Registration

Athlete Information
Athlete Name*
First Last
Gender*
- Male
- Female
Athlete Date of Birth*
MM slash DD slash YYYY
USA Water Polo ID#
Athlete Cell Phone Number
Athlete Email
t-Shirt Size
Male Suit Size
Female Suit Size
Medical Conditions
Parent 1 Information
Parent 1*
First Last
Parent 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent 1 Email*
Parent 1 Cell Phone Number*
Parent 2 Information
Parent 2
First Last
Parent 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent 2 Email
Parent 2 Cell Phone Number
Comments
Registration Fee
Price:
Orange / Blue Team $66/month*
Price:
Todays Total
$0.00
Credit Card
Card Details
Cardholder Name

Athlete Information