Raider Water Polo Sign-Up 
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Email *
ATHLETE'S INFORMATION
Athlete's Full Name (first and last name) *
Athlete's Gender *
Athlete's Date of Birth *
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Athlete's School *
Athlete's Grade *
Athlete's Cell Phone Number (we will add your son/daughter to the club's WhatsApp group chat)
Athlete's Primary Home Address *
USA Water Polo Membership (USAWP)
Raider Water Polo is a club water polo team sanctioned by USA Water Polo. All participants are required to have a USA Water Polo membership in order to participate in any club event. Membership levels vary based on participation. There is a free 2-week trial membership for new members only. 


Note: If your son/daughter plans to participate in the Junior Olympics in July, they will need a Gold membership

UPGRADE AVAILABLE: All current USAWP Athlete memberships are able to be upgraded to a higher level. Cost is the difference in price plus an $8 fee, with the exception of promotional memberships which may have different requirements or fees. A new membership card will be sent with any upgrade. A lapsed membership cannot be upgraded, you must renew.
Athlete's USA Water Polo Membership Number *
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Full Name (First and Last) *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 Full Name (First and Last)
Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Email Address
EMERGENCY CONTACT INFORMATION
Emergency Contact Full Name (First and Last) *
Emergency Contact Relationship *
Emergency Contact Cell Phone Number *
Emergency Contact Address *
ATHLETE'S CODE OF CONDUCT
Participation is a Privilege:
Membership in Raider Water Polo and participation in Raider Water Polo sanctioned events are privileges, not rights.  Those privileges may be withdrawn, either for a period of time or permanently, in the event that an athlete violates these Rules.

Sportsmanship: 
Athlete members of Raider Water Polo are expected to demonstrate good sportsmanship. This includes, but is not limited to, avoiding the following conduct:
1. Hazing or taunting anyone;
2. Physically or verbally abusing anyone, but not limited to making derogatory comments about such person’s race, sex, religion, age, disability, national origin or sexual orientation;
3. Using obscene gestures, or profane or unduly provocative language toward anyone;
4. Publicly and unduly criticizing anyone, but not limited to, inciting others to engage in conduct in violation of these Rules; and
5. Negative recruiting by making unduly derogatory statements about members or coaches of another team.
In addition to not engaging in the foregoing types of conduct themselves, Raider Water Polo athlete members are expected to disassociate themselves from others who may be engaged in such conduct.

Violent Behavior:
Although water polo is a physical sport, athletes are expected to refrain from engaging in any act with the intent of causing injury to another athlete.

Drugs and Alcohol:
Athlete members of Raider Water Polo are strictly forbidden from use, possession, or providing alcohol or drugs in violation of local, state, or national laws.  

USA Water Polo:
Athlete members of Raider Water Polo are required to be members in good standing of USA Water Polo.  This means that all athletes are required to have a current membership with USA Water Polo at all times while participating in Raider Water Polo.  Athletes are also required to adhere to all rules of behavior and codes of conduct established by USA Water Polo. Athletes need to bring with them their current USA Water Polo membership card (or temporary card), which has a photo of the athlete, to all tournaments and league games.

Enforcement:
Alleged violations of the Rules, contained herein or otherwise established by Raider Water Polo, shall be addressed by the Head Coach at a meeting with the athlete and parents.  The Head Coach may impose such sanctions as he/she deems appropriate including, but not limited to, placing the offending athlete member on probation, suspending the athlete member’s membership in Raider water polo for a period of time, or permanently barring the athlete member from membership in Raider Water Polo with no refund, depending upon the severity of the violation and the history, if any, of any previous violations of these Rules by the athlete member.

Acknowledgement and Agreement: 
By signing below, I am acknowledging that I  have read and fully understand the Rules of Conduct and I am agreeing to the terms and conditions set forth in the Rules of Conduct.  

ATHLETE'S ELECTRONIC SIGNATURE *
TODAY'S DATE *
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PARENT/GUARDIAN'S ELECTRONIC SIGNATURE *
TODAY'S DATE *
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We often take photos and videos while athletes are practicing or competing to post on our private Instagram account (@RaiderWP) or on our website. Do you give Raider Water Polo permission to take and use photos of your child in the above mentioned manner? *
RELEASE, MEDICAL WAIVER AND AUTHORIZATION FOR TREATMENT OF MINOR
As the parent or guardian of  the athlete named above, who is a minor, I understand the risks involved in the sport of water polo, and that participation in Raider Water Polo Club (“Raider WPC”) and its activities could result in the injury, sickness or death of my child.  I give my child permission to participate in all Raider WPC activities.  It is understood that Raider WPC is not run by Ransom Everglades School and that Raider WPC does  not provide medical insurance covering injuries of any nature.

 I, on behalf of myself and my child, or anyone claiming through myself or my child, hereby forever release Raider WPC, Ransom Everglades, its successors, officers, agents, representatives, coaches and employees from all claims, demands, and causes of actions of any nature whatsoever, including but not limited personal or bodily injury, property damage, death or accident of any kind, arising out of or in any way related to my child’s participation in Raider WPC howsoever the injury is caused.  

I hereby authorize the Raider WPC, its agents, representatives, employees, and coaches to act with their best judgment in case of any emergency requiring medical attention to my child.  I consent to any emergency x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Chapter 458, Florida Statutes, which is referred to as the Medical Practice Act.

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of Raider Water Polo, its representatives, agents, employees, and coaches our to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable; and Raider Water Polo, its representatives, agents, employees or coaches or any organization involved assumes any financial responsibility for exercising this action.

I certify that my child is medically able to participate in Raider WPC and is free from any communicable, infectious or contagious diseases.

By electronically signing below, I hereby agree to and accept the terms and conditions of this form.   *
Today's Date *
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Physician's Name *
Physician's Phone Number *
Medical History
Health Insurance Company *
Name of Insured *
Policy Number *
A copy of your responses will be emailed to the address you provided.
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