PCCA Summer Water Polo Registration
SUMMER WATER POLO
JUNE 6 – JULY 27, 2016
Swimmer Name: __________________________________ Birth Date: _____/______/_____ Age: _____
Last
First
Parent/Guardian(s) Name:________________________________________________________________
____ A Swimmer Info/Waiver form is on file for my child:
Winter ’16
Fall ‘15
Summer ‘15
Spring ‘15
Main Email Contact:_______________________________________________________ (please print neatly)
T-Shirt Size: (Circle One)
YOUTH / ADULT
Small
Medium
Large
Extra-Large
____Youth Water Polo (Swimmers entering 4-8th grade)
Location: Sequoia High School
Days: Monday & Wednesday
Time: 2:30-3:45pm
____High School Water Polo
(swimmers entering 9-12th grade)
Location: Sequoia High School
Days: Monday & Wednesday
Time: 6:45-8:00pm
Summer PCCA Swim Team Member _____$125
Non-member
_____ $175
*Second Child - less $10
*Third/fourth Child – less $20
*Second Child -$20, Third Child -$40 from original pricing
Method of Payment: (please X one)
(
) PCC Member ID Number____________________
(
) Check #______________
(
) Credit Card (paid at PCC front desk, please attach receipt)
Total Amount Paid: $____________ Date: _____/_____/_____
3623 Jefferson Ave., Redwood City, CA 94062
peninsulacommunitycenter.com