Finally, a Water Polo camp focusing on female athletes! June 27 - June 30, 2018 Gauchos Girls Water Polo Camp Medical Waiver/Emergency Contact I understand the risks involved in the sport of water polo, and that participation in the Gauchos Girls Water Polo camp could result in the injury, sickness or death of my child. I give my child permission to participate in all activities at camp. It is understood that this camp is not run by the University of California, Santa Barbara and that Gauchos Girls Water Polo Camp does NOT provide medical insurance covering injuries of any kind for the duration of the camp. The undersigned hereby releases Gauchos Girls Water Polo Camp, the University of California, Santa Barbara, its successors, officers, agents and employees from all claims, demands, and causes of actions resulting from participation in the water polo camp. I further hereby, on behalf of myself, my child and anyone claiming through myself or my child, do FOREVER RELEASE the University of California, Santa Barbara, its trustees, officers, employees, volunteers, students, agents and assigns from any cause of action, claims, or demands of any nature whatsoever, including but not limited to a claim of negligence which I, my child, or anyone claiming through myself or my child, may now or in the future have against University of California, Santa Barbara on account of personal injury, bodily injury, property damage, death or accident of any kind, arising out of or in any way related to my child’s participation in the Camp howsoever the injury is caused. I certify that my child is medically able to participate in the Camp and is free from any communicable, infectious or contagious diseases. I, the undersigned, do hereby grant permission to Gauchos Girls Water Polo to post photos, video, and/or other media to benefit the Gauchos Girls Water Polo Camp. In case of emergency, parent/guardian can be reached at: Home Phone Cell Phone Known Medical Conditions: I hereby acknowledge that the aforementioned minor child is covered by medical insurance as follows: Insured Company Policy Number Company Phone # I hereby authorize the directors of Gauchos Girls Water Polo Camp to act with their best judgment in case of any emergency requiring medical attention. Signature of Parent/Guardian Date Print Parent/Guardian Name Please include a printed copy of your insurance card with your registration. Gauchos Girls Water Polo Camp Camp Fees Registration Fee Overnight $635.00 Team 5+ $585.00 Team 10+ $485.00 Team 15+ $385.00 Commuter $455.00 Non-refundable deposits $200 HEALTH & SAFETY A certified trainer will be available for minor injuries and ailments. A medical release form is required and must be completed prior to camp. Parent/Guardian health insurance is the primary coverage in the event of an injury. Please send a copy of insurance card with camper and include with application form. All athletes need to have a current American Water Polo or USA Water Polo membership. American Water Polo Memberships can be purchased at http:// www.americanwaterpolo.org/join-now-. USA Water Polo Memberships can be purchased at https://webpoint.usawaterpolo.com/wp/memberships/ join.wp Schedule of Events 12pm Camp check in at Tropicana Del Norte 1:15pm Depart for campus pool 2:00-4:30pm Training session 5pm Dinner at Trop cafe 6pm Guest speaker/evening activities 7pm Day campers pick up at Tropicana Del Norte Sample Day 8am Breakfast at Trop cafe 9-11:30am Training session 12pm Lunch 1:30pm Depart for campus pool 2-4:30 Training session 5pm Dinner 6pm Guest Speaker/evening activities 7pm Day campers pick up at Tropicana Del Norte 10pm Lights out