Oakwood Water Polo Club
Summer Athlete Registration Form 2017
Dates: May 22 – July 20, 2017
Days: Monday, Tuesday & Thursday
Times: 5:30 pm – 8:30 pm until June 12th.
8th. Grade & under - Boys & Girls 5:30 pm-7:00 pm / June 12th. 11:00 am- 12:30 pm
High School age groups 7:00 pm-8:30 pm / June 12th. 9:00 am – 11:00 am
All members must be Registered with USAWP - Oakwood Water Polo #20514
Please provide us with your current 2017 USAWP membership Number
Athlete’s Name: ______________________________________________
Parent’s Names: ______________________________________________
Address: ____________________________________________________
City / Zip: ___________________________________________________
Phone Number: _______________cell: ___________________
E-mail address: __ _____________________________________________
Date of Birth: ____________________
Age: _________________
USAWP Membership Number: ________ Expiration Date: _________
Level of Membership: Bronze ______ Silver__ ___ Gold ____
Emergency Contact Phone___________________________
Early Registration Fee, $300 if paid in full by April 30th. ($100 discount)
Early Registration Fee, $350 if paid in full by May 22nd. ($ 50 discount)
Registration fee: $400, after May 22nd.
(if necessary, you can split into 2 payments - $200 - $200)
*Two checks due at time of registration (one postdated for June 16th.)
Please go to “oakwoodwaterpolo.org “
to complete & submit your registration, electronicly.
You can mail payment to address provided below
To be filled in by OWP Staff:
Paid _____ Check# _____ Cash _____
USA Card_____ Med Release_____ Code of Ethics_____
Submit with check payable to:
Oakwood Water Polo Club, 932 Oak St., Brentwood, CA 94513