Pacific Polo: Registration Form Player Name_______________________________________________________________________ Birth Date___________________________________ Current Age____________________________ Address___________________________________________________________________________ City_____________________________________State_____________Zip______________________ Home Phone #___________________________ Cell Phone__________________________________ Parent or Guardian Name(s)____________________________________________________________ E-mail Address______________________________________________________________________ How did you hear about Pacific Polo?____________________________________________________ Previous playing experience?___________________________________________________________ In consideration of the acceptanceof this registration, we the undersigned polo player and parent/guardian, intending to be legally bound, do hearby waive, release and forever discharge any and all rights and claims for damage which we or either of us may hereafter have against the organization's club, its representitives,and its coaches for any and all damages which may be sustained and/or suffered by me or my children in connection with participating in the water polo program. Signature of parent/guardian______________________________________Date__________________ Contact Information: (858) 722-1847 , Imckercher@aol.com, pacificpolo.net