The NorCal Water Polo Club is a
USA Water Polo (USAWP) affiliated club whose primary mission is to provide top
tier professional coaching and competitive opportunities to its participants.
Program
Information: The NorCal winter program will include 2-3
workouts per week, and may include high level weekend competitions.
Dates: December 6, 2011 –
February 4, 2012 (there will be breaks for the Holidays)
Days
& Times: Tuesdays and Thursdays, 5:15 pm -7:15 pm;
Saturdays, 10:30 am-12:30 pm
Venue: Menlo School, 50 Valparaiso Avenue, Atherton CA
Cost:
$385
per athlete, $50 sibling discount. Roster spots will be filled on a first-come
first-served basis with a limited number of participants in each age group.
Please give Coach Dorst your completed form with check, or mail to: NorCal
Water Polo Club, P.O. Box 1211, Menlo
Park, 94026. Full payment is due no later than January 7th. Contact
Coach Dorst for scholarship information.
Contacts:
Please
contact Coach Dorst at cdorst@yahoo.com (or
650.248.7360) with any further questions on the NorCal program.
Coaching Staff:
·
Chris Dorst: US Olympic Team, 1980 & 1984; NCAA
Champion, All-American, Stanford University; USA Water Polo Hall of Fame
·
Brendon Reutebuch: Head Girls' Coach, St. Francis
High School; 6-time CCS Champion
·
Fana Fuqua: Head Girls' Coach, Menlo School ; UC
Berkeley, National Team Member; Owner, Fuqua Fitness Adventures
Tournaments: Tournaments
are scheduled for a number of weekends during the winter; there may also be a competitive
training trip. Entries will be subject to player availability and may require
additional payment.
USWP
Registration: All athletes must be registered
with USAWP for 2011 and 2012. There can be no exceptions. Players may register
online at www.usawaterpolo.com if they have not already
registered for the 2012 competition year. The USWP number for the NorCal Water
Polo Club is #1576.
REGISTRATION
PERSONAL
Player’s Name:
______________________________________
Current Age: ______ Birth
Date:___/____/___
Player’s
Email: _____________________________________________________________________________
Family Home
Address: ______________________________________________________________________
City: ___________________________________________________
State: _________ Zip: _______________
Family/Parent’s
Email: ______________________________________________________________________
Telephone:
_________________________________ Alt.
Telephone: ________________________________
What school
are you attending? _______________________________________________________________
Do you have
any allergies or medical conditions we should be aware of? _______________________________
________________________________________
US Water Polo registration number: ____________________
Emergency
Contact Name(s): _________________________________________________________________
Emergency
Contact’s Daytime Phone(s): __________________ Contact’s E-Mail: _______________________
REGISTRATION
AND PAYMENT
Checks only, please. q A check for
$_______________, payable to NorCal
Water Polo.
Registration Agreement
1. I hereby authorize
the NorCal Water Polo program staff to act for me according to their
best judgment in any emergency requiring medical attention, and hereby waive
all rights and claims and release the program and its staff, agents and
directors, and Woodside High School, Menlo School, and Sequoia Union High
School District, for any and all liability for any injuries, illness or damages
while my child is enrolled in the program. I take complete responsibility for
any and all medical expenses incurred.
2. No
application is accepted and no spaces will be reserved for athletes until full
payment has been received.
3. The
instructional nature of our program necessitates constant expenses and the
employment of specialized personnel. Therefore, there will be no makeup days,
credits or refunds given for absence. If a participant cannot return to the
program owing to illness or accident, a doctor’s note must accompany the
withdrawal request. In that case the refund will be prorated.
4. NorCal Water Polo reserves the right to cancel any program due to
insufficient enrollment. NorCal Water Polo Water Polo may use photos
taken during the program for promotional purposes.
5. If
a participant is expelled for disciplinary reasons, the fees will be forfeited.
I have read this agreement and agree
to all terms and conditions.
Signature
of Parent:
___________________________________________________________ Date ___________________