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REGISTRATION PLAYER DETAILS: |
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First Name of Player
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Last Name of Player
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Date of Birth
(YYYY/MM/DD)
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Gender of Player
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Athlete's email address
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Athlete Home Address - Street Number and Name
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City of Residence
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Postal Code
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Home Phone Number (ex: 604-555-1234)
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Parent/Guardian(1) First and Last Name
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Parent/Guardian (1) cellphone number (ex: 604-555-1234)
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Parent/Guardian (1) email address {if under 18}
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Parent/Guardian(2) First and Last Name
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Parent/Guardian (2) cellphone number (ex: 604-555-1234)
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Parent/Guardian (2) email address {if under 18}
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MEDICAL INFORMATION: |
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Athlete Care Card Number
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Name and Phone Number of the Athlete's Primary Medical Doctor
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Emergency Contact: FirstName LastName PhoneNumber
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Does Athlete have any special medical considerations? If Yes, please explain
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Does Athlete use any medications that the club should be aware of. If Yes, please detail
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Does Athlete have any special dietary considerations? Please detail
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Are you registered with a Fall 2011 Lower Mainland League Club (LMWPL)?
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If yes - please specify the name of the Lower Mainland Club you are registered.
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WHICH PROGRAM ARE YOU REGISTERING FOR (Program Fees Listed Here) |
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Girls 14U & 12U Performance Development, Birth Years 1998 & younger:
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* Atheletes can swim as BCSSA "S" Cat swimmers next summer regardless of the number of hours in Water Polo and other non-speed swimming aquatic sports. |
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Boys 14U & 12U Performance Development, Birth Years 1998 & younger:
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* Atheletes can swim as BCSSA "S" Cat swimmers next summer regardless of the number of hours in Water Polo and other non-speed swimming aquatic sports. |
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18U/16U Performance Plus, Birth Years 1994, 1995, 1996, 1997
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22U Performance for Life - Birth Years 1993 & older
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I certify that I have read and understand the various club policies and documents listed below and by submitting indicate my acceptance and adherence of all.
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