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Athlete Information

Athlete Name:*

First Middle Last

Preferred Name (Nickname):

Date of Birth:*

Sex:*

Suit Size:*

t-Shirt Size (Adult Size):*

School / Club:*

Location*

Position:*

Utility
Goal Tender
2 Meter Defender
2 Meter Offense
Driver / Flat
Wing

Handed:*

Athletes Email:*

Athletes Cell Phone Number:*

USA Water Polo ID#:

Medical Information

Insurance Company:*

Insurance Policy Number:*

Insurance Billing Address:*

Medications

My 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 Release

Photo / Video Release Form:*

Please be aware that GWP, UF, or BIWPA, can use photos / videos taken at camp for future marketing purposes.

Parents / Guardians

Parent / Guardian 1:*

First Last

Parent / Guardian 1 Email:*

Parent / Guardian 1 Cell Phone:*

Registration

Session Registration*

Day / Residential*

Day
Residential

Roommate Requests:

Add-Ons

Total & Check Out (Deposit)

Registration Fee

Price:

Coupon Code:

Total

$0.00

Credit Card

Card Details

Cardholder Name

Gator Water Polo

Gainesville, FL

Summer 2022 Florida International Water Polo Event (Deposit Page)