NEW ATHLETE(S) REGISTRATION – FALL 2023 Athlete 1 Name*FirstLast Athlete 1 Mobile Phone Athlete 1 Email Athlete 1 Gender*MaleFemale Athlete 1 Date of Birth*01020304050607080910111213141516171819202122232425262728293031Day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMonth / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Athlete 1 Age as of August 1, 2023* Athlete 1 Enrollment*14U WP12U WP10U WP14U WP/SWIM12U WP/SWIM10U WP/SWIMUSA Water Polo Memberships: https://raptorsports.org/usa-water-polo/USA Water Polo: Silver Level Required Athlete 1 USA Water Polo Membership Number:* Athlete 1 USA Water Polo Membership Type*GoldSilverBronzeOtherRegister additional athletes (if applicable). Otherwise click NEXT at the bottom to proceed to Parent Information. Athlete 2 NameFirstLast Athlete 2 Mobile Phone Athlete 2 Email Athlete 2 GenderMaleFemale Athlete 2 Date of Birth01020304050607080910111213141516171819202122232425262728293031Day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMonth / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Athlete 2 Age as of August 1, 2023 Athlete 2 Enrollment14U WP12U WP10U WP14U WP/SWIM12U WP/SWIM10U WP/SWIM Athlete 2 USA Water Polo Membership Number: Athlete 2 USA Water Polo Membership TypeGoldSilverBronzeOtherUSA Water Polo Memberships: https://raptorsports.org/usa-water-polo/USA Water Polo: Silver Level Required Athlete 3 NameFirstLast Athlete 3 Mobile Phone Athlete 3 Email Athlete 3 GenderMaleFemale Athlete 3 Date of Birth01020304050607080910111213141516171819202122232425262728293031Day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMonth / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Athlete 3 Age as of August 1, 2023 Athlete 3 Enrollment14U WP12U WP10U WP14U WP/SWIM12U WP/SWIM10U WP/SWIMUSA Water Polo Memberships: https://raptorsports.org/usa-water-polo/USA Water Polo: Silver Level Required Athlete 3 USA Water Polo Membership Number: Athlete 3 USA Water Polo Membership TypeGoldSilverBronzeOther Address* Street Address City State / Province / Region Postal / Zip Code Home Phone Mothers Name*FirstLast Mothers Email* Mothers Mobile Phone* Fathers Name*FirstLast Fathers Email* Fathers Mobile Phone* Emergency Contact (Other Than Parents)*FirstLast Emergency Contact Phone* Emergency Contact Relationship* Physicians Name* Physicians Phone* Health Insurance Company* Group # Allergies and/or other medical conditions To comply with Federal Nondiscrimatory practices and reporting guidelines related to our 501 (c)(3) exemption as a school, please select the choice that best describes your athlete. This section is optional, if you do not feel comfortable answering, please choose “no answer”. * Hispanic African American (Not Hispanic)American Indian/Alaska NativeWhite (Not Hispanic)Asian (Not Hispanic)Pacific Islander (Not Hispanic)Filipino (Not Hispanic)Two or more (Not Hispanic)No Answer My child, *is a participant in the activities provided by the Raptor Sports School Inc. and has my permission to participate in all activities including but not limited to practices, scrimmages, games & tournaments. I certify that my child has full medical insurance. I also certify, to the best of my knowledge that my child is physically fit and able to participate in sporting events. I acknowledge that water polo and/or swimming is an extreme sport and can lead to minor or serious bodily injury. With full understanding of the potential risks, I hereby assume those risks of participation. In the event of an injury, I assume financial responsibility for the bills incurred. In the event of injury or sudden illness, I as legal guardian, hereby grant my permission for my child to be treated by a qualified and licensed physician in the event that immediate treatment is necessary, as determined by the attending physician. Permission for treatment is authorized in the event that I am unable to be reached following a reasonable effort to do so. I understand that it is my responsibility to inform the club administration when my contact and/or insurance information changes. I also agree to pay all fees associated with club activities: session registration fees, equipment fees, travel fees where applicable, etc. Further, I understand that Raptor Sports School Inc. is a separate entity and it is not associated with Chino Hills High School, Diamond Bar High School, Walnut High School, Chino Valley Unified School District or Walnut Valley Unified School District. I certify that I have read and understand the release of liability. I understand that the release of liability applies to all activities or events sponsored by Raptor Sports School Inc. I understand that I have given up substantial rights. I,* the undersigned parent or legal guardian of the athlete,*execute the foregoing release for and on behalf of the minor named herein. I hereby bind the minor, all other assignees and myself to the terms of this release. I represent that I have legal capacity and authority to act for and on behalf of the minor named herein. I agree to indemnify and hold harmless the persons or entities named in this waiver and release for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the execution of this release. I fully consent to my child's participation in events sponsored by Raptor Sports School Inc. This permission is granted for this period of time: August 1, 2023 to July 31, 2024. Enter Initials To Authorize * Date *Non Discrimination Policy The Raptor Sports School Incorporated does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, admission of students, selection of volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, clients, volunteers, subcontractors, students, vendors, and clients.Statement of High School/Club Player Participation Participation in Raptor Water Polo does not guarantee any student athlete a place on any High School Water Polo Team, nor is attendance to Raptor Water Polo required by any known High School Water Polo Team to compete in their respective program.Behavioral Standard Raptor Sports expects its parents, coaches, and players to set the example for behavior and sportsmanship. Should a participant’s behavior conflict with this expectation Raptor Sports reserves the right to discipline the offending party as necessary. Discipline could include suspension or expulsion from the program. Raptor Sports will not issue refunds for games or practices lost due to disciplinary infractions. ATHLETE: Please verify you have read and understood our nondiscrimination policy, behavioral standards and statement of High School & Club Player participation. I understand the nondiscrimination policy, behavioral standards & statement of High School & Club Player participation.*Yes PARENT: Please verify you have read and understood our nondiscrimination policy, behavioral standards and statement of High School & Club Player participation. I understand the nondiscrimination policy, behavioral standards & statement of High School & Club Player participation.*Yes IMAGE/INFORMATION PERMISSION FOR CLUB MEDIA (Please Select ONE): I hereby grant to The Raptor Sports School Incorporated and its affiliates the right to use my child’s image, name, and biographical information as they may desire, in all media and in all forms including, but not limited to, publications, any televised photography and recordings. Examples include, but are not limited to, the newspaper and other print news media, televised news media, promotional print media and website. I do not grant The Raptor Sports School Incorporated the right to use the image or information of the student athlete specified above.*GrantDo not Grant Enter Initials To Authorize* Date*SubmitReset
