Pride Water Polo Academy

Welcome to Pride Water Polo Academy!!!

To join our team, please follow these instructions:

1) If you are not currently a member of USA Water Polo please fill out the forms at this link before continuing: USA Water Polo Registration

2) To finalize your registration, please complete this online registration form. You will be asked to provide a credit card for payment. Please note that this online entry system helps Pride Water Polo Academy expedite new member and renewing member registrations. It provides members a way to easily update their information in our data base. This is a secure system so there is no risk to you.

Thank you and welcome to Pride Water Polo Academy!!!

PLAYER INFORMATION:

* Starred fields are required

First Name *

Preferred (Nickname)

Last Name *

Create Password

Sex *

Female Male

Birth Date *

School *

Graduation Month/Year *

Cell Phone *

Texting Cell

Mobile provider

Email *

Country *

Street *

Street 2

City *

State *

ZIP Code *

USWP Number *

Exp. Date

(12/31/yyyy) USA Water Polo information/Sign-up

USWP Club Name

Left/Right-handed?

Left Right Both

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *

Medical Insurance Carrier: •

Medical Insurance #: •

Physician’s Name: •

Physician’s Phone: •

Allergies: •

Additional Notes on Medical History (please list below): •

Tuesday, May 7 - Wednesday, July 31, 2024

Registration

Tune Up Cup Spring Tournament '24

Emergency Contact