Waiver/Tryout Form - Vancouver Vipers Water Polo

Player's Name*

First Last

Player's Date of Birth*

Gender*

Male
Female
Non-binary

Pronouns (optional)

she/her
he/him
they/their

Allergies/Medical Condition

Primary Email Address*

Alternate Email Address (optional)

Name of Parent/Guardian

First Last

Parent/Guardian's Cell Number (optional)

Name of Parent/Guardian (optional)

First Last

Parent/Guardian's Cell Number (otptional)

Program (select program athlete would like to try)*

Splashball/9U (2016-2018)
11U (2014-2015)
13U (2012-2013)
15U (2010-2011)
18U (2007-2009)
19U / Masters (2006 & older)

Player's experience with swim lessons (if applicable)*

Please provide information about your player's swim experience - such as current or past lessons. This information helps the coaches during their trial sessions.

Currently enrolled in swimming lessons at a community centre
Currently enrolled is swimming lessons at a private pool (eg Aquaventures)
No longer taking swimming lessons

How did you find out about us?*

Please share more about your player's swimming experience, such as how they have been swimming, etc. If they are currently taking swimming lessons, what level are they in? Are they comfortable in deep water?

Acknowledgement*

I certify that the information on this form is correct to the best of my knowledge and that as the parent/guardian of the above named player(s), hereby gives approval to his or her participation in all Water Polo activities. I assume all risk and hazards incidental to such participation and to traveling to and from activities, and I do hereby waive, release, absolve, indemnify the organizers, coaches, managers, referees, assisting or participating parents and persons transporting our son or daughter to or from activities, for any claim arising out or any injury to our son or daughter.

The club reserves the right to change practice times and locations based on pool availability.

This information is required insurance purposes only and will not be shared.

By clicking this box you agree with the following statement:*

Agreement to Play

By clicking the box above you agree to the following: I understand that my child is responsible for observing the rules of the club at all times. I agree that my child will participate at his/her own risk. I give permission for my child’s name, phone number and address to be provided to Water Polo West in order to register for insurance coverage.

I Agree