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Name of Athlete *

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Last

Age of Athlete *

Parent/Contact Name *

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Last

Email *

Polo/Swimming/Ball Sport experience *

Here's the unavoidable legal stuff

How'd you hear about us *

USA Water Polo is the sport's governing body, it provides registered clubs with insurance, but the athletes also need to be members. You can get a free trial membership HERE

Enter the USAWP# you just received *

1) I, the parent/guardian and the registrant, a minor, assume full responsibility and liability as follows: Recognizing the possibility of physical injury associated with water polo and in consideration for the San Jose Express Aquatics accepting the registrant for its water polo programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify the San Jose Express Aquatics, affiliated organizations, their employees and associated personnel, including the owners of the pools and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

2) San Jose Express Aquatics feels it desirable to provide club coaches with the parents or guardians’ permission to sign the necessary authorization for emergency treatment if it may be necessary. It is understood that in all cases the officials will attempt to secure the advice of the parent by telephone before using the authorization given by this form. This authorization is similar to that which a number of parents furnish to friends or relatives in whose care their children may be left. Our permission is hereby given to the coach or representative of the San Jose Express Aquatics to authorize by his or her signature whatever medical or surgical treatment may be considered necessary or advisable by the physician or nurse in attendance in the event of an accident or medical emergency involving my child while participating in the San Jose Express Water Polo Club program.

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TRY OUT WATER POLOFOR FREE

Want to try to water polo, but you're not sure if you want to commit. Try it out on us.Sign up here, and we'll get back to you.​

TRY OUT WATER POLO
FOR FREE

Want to try to water polo, but you're not sure if you want to commit. Try it out on us.
Sign up here, and we'll get back to you.