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Fall 2023 Viking Water Polo Registration

The REGISTRATION FORM below is for the Viking Water Polo Club, Fall 2023 Session. The cost is $250.00 and you may pay via Paypal or by check.  The instructions for payment will be included at the end of the registration and in the email confirmation you will receive.  Please contact Pam Hege ([email protected]) or William Higgins ([email protected]) with any questions about this registration or payment.

Please note that the registration fee includes: pool rental fees, coaches’ fees, scrimmage pool fees, referee fees. Practices will be held at the Dynamo Swim Club (50-meter pool) located at 3119 Shallowford Rd NE, Chamblee, GA 30341.

If you have not registered with the American Water Polo organization (AWP), you must do so BEFORE completing the Registration Form below (in order that the player can be assigned an AWP number). To register with AWP, please go to https://americanwaterpolo.org/join-now/ and click Join Now. The American Water Polo membership is further required by the Georgia High School Athletic Association to allow students to compete in Georgia Water Polo events. The AWP Membership also covers the player's athletic liability and insurance coverage for practice and games.

Parent/Guardian Information
  • At least one parent/guardian registration is required. New accounts will be sent an email confirmation message with instructions to set up a password.
  • At least one parent/guardian email address must be provided. Check the boxes to indicate which parent/guardians should receive team-wide emails.
  • At least one parent/guardian is required to volunteer.
  • Previously registered parents/guardians cannot be edited during registration. Please contact your team's admin to request edits.
First Name * Last Name * Email Address *
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Athlete Information
  • At least one athlete registration is required.
  • Previously registered athletes cannot be edited during registration. Please contact your team's admin to request edits.
First Name * Preferred Name Middle Initial Last Name * Competition Category * Birth Date *
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Home Address

AWP Number

What is the player's AWP number? *

Athlete Email

What is the email address of the athlete? *

Athlete Phone

What is the mobile number for the athlete? *

Athlete Experience

Has the athlete played water polo before? *

Athlete's Grade

What grade is the player current in at school? *

Athlete's School

What school does the athlete currently attend? *

Dynamo Club Facilities Waiver

For and in consideration of the benefits to me from the use by me and/or my child(ren) of the facilities of Dynamo Parents Club, Inc. (Dynamo Swim Center) and other good and valuable consideration, the undersigned, individually and for his/her heirs and personal representatives, hereby release Dynamo Parents Club, Inc. directors, officers, agents, swim team members and employees from any and all claims of any kind or nature whatsoever, arising out of the use by me and/or my child(ren) of said facilities. The undersigned, individually and for his/her heirs and personal representatives, further agree to indemnify, defend and forever hold harmless Dynamo Parents Club, Inc. and their directors, officers, agents, swim team members and employees from any and all liability and loss whatsoever, (including and cost of defending claims) arising out of said use of said facilities to the extent permitted by Georgia law.

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Viking Polo Team Waiver
  • The risk of injury from the activities involved in the Lakeside Viking Water Polo Programs is significant, including the potential for permanent disability and even death, and while particular rules, equipment and personal discipline may reduce the risk, the risk of serious injury to the Swimmer does exist; and
  • On behalf of Swimmer, myself and spouse, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF RELEASEES or others, and assume full responsibility for the participation of Swimmer in the Lakeside Viking Polo Team Programs; and
  • On behalf of Swimmer, I willingly agree to comply with the states and customary terms and conditions for participation in the Lakeside Viking Team Programs. If I observe any unusual significant concern in the readiness of Swimmer for participation or in the Lakeside Viking Team Programs, I will remove Swimmer from participation and bring such to the attention of the nearest official immediately, and
  • On behalf of Swimmer, myself, my spouse and our heirs, personal representatives and next of kin, I HEREBY RELEASE Lakeside Water Polo Club and any other swim facility used as interim practice facilities, its directors, officers, agents and/or employees, other participants, sponsoring agencies, facility owners and lessor, sponsors and advertisers (the "Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to Swimmer's involvement or participation in the Lakeside Viking Team Programs, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASES OR OTHERWISE, to the fullest extent permitted by law.
  • On behalf of Swimmer, myself, my spouse and our heirs, personal representatives and next of kin, I HEREBY INDEMNIFY AND HOLD HARMLESS ALL THE ABOVE Releases from any and all liabilities incident to Swimmer's involvement or participation in the Lakeside Viking Polo Team Programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS AND HAVE HAD ALL MY QUESTIONS FULLY ANSWERED, FULLY UNDERSTAND THAT I HAVE THE CHOICE OF NOT PARTICIPATING IN THE LAKESIDE VIKING WATER POLO TEAM PROGRAMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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