test Summer 2022 Florida International Water Polo Event Athlete InformationAthlete Name:* First Middle Last Preferred Name (Nickname): Date of Birth:* MM slash DD slash YYYY Sex:*MaleFemaleSuit Size:*24262830323436384042t-Shirt Size (Adult Size):*Extra SmallSmallMediumLargeExtra LargeXX LargeSchool / Club:* Location* Position:* Utility Goal Tender 2 Meter Defender 2 Meter Offense Driver / Flat Wing Handed:*RightLeftAmbidextrousAthletes Email:* Athletes Cell Phone Number:*USA Water Polo ID#:Medical InformationInsurance Company:* Insurance Policy Number:* Insurance Billing Address:* MedicationsMy child can be given Tylenol (Acetaminophen)?* Yes, (Tylenol (Acetaminophen)) No, (Tylenol (Acetaminophen)) My child can be given Advil (Ibuprofen)?* Yes, (Advil (Ibuprofen)) No, (Advil (Ibuprofen)) My child can be given Tums (Antacids)?* Yes, (Tums (Antacids)) No, (Tums (Antacids)) Medications: Prescription medicine/dosage your child is currently taking: Allergies: (Food/Other):Medical History: Conditions/Special Needs:Photo / Video ReleasePhoto / Video Release Form:*Yes (I agree with the photo release)Please be aware that GWP, UF, or BIWPA, can use photos / videos taken at camp for future marketing purposes.Parents / GuardiansParent / Guardian 1:* First Last Parent / Guardian 1 Email:* Parent / Guardian 1 Cell Phone:*RegistrationDay / Residential* Day Residential Session Registration* Day Camper Session 1 Day Camper Session 2 Day Camper Session 3 Day Camper Session 1 & 2 Day Session Camper 2 & 3 Day Session Camper 1 & 2 & 3 Session Registration* Residential Camper Session 1 Residential Camper Session 2 Residential Camper Session 3 Residential Camper Session 1 & 2 Residential Camper Session 2 & 3 Residential Camper Session 1 & 2 & 3 Roommate Requests: Extra Night Stayovers & Gap WeekendsExtra Night Pre-Camp Sunday Night No Pre-Camp Sunday Night $0 Pre-Camp Sunday Night $90 Extra Night Post-Camp Friday Night No Post-Camp Sunday Night $0 Product Name No Gap Weekend $0 Gap Weekend Between Session 1 Between Session 1 & 2 $650 Gap Weekend Between Session 2 Between Session 2 & 3 Both Gap Weekends 1 & 2 Between Session 1,2 / 2,3 $1300 Add-OnsVideo Performance Evaluation Video Performance Evaluation $50 No Video Performance Evaluation $0 Flight InformationIn-Bound Flight Information No Airport Pickup $0 Gainesville Airport Pickup $0 Orlando Airport Pickup $100 In-Bound Flight InformationPlease include: airport, carrier, flight number, time of landing. If you do not have your flights booked, please email the flight information to coach@gatorwaterpolo.com when you have booked your flights. Out-Bound Flight Information No Airport Drop-off $0 Gainesville Airport Drop-off $0 Orlando Airport Drop-off $100 Out-Bound Flight InformationPlease include: airport, carrier, flight number, time of departure. If you do not have your flights booked, please email the flight information to coach@gatorwaterpolo.com when you have booked your flights.Total & Check Out (Deposit)Registration Fee Price: Coupon Code: Total $0.00 Credit CardCard Details Cardholder Name
