Water Polo Registration Form Child InformationChild's Name* First Last Child's Age*As of June 14thHas your child ever played water polo before?*YesNoParent InformationHiddenMember #0Name* First Last Email* Phone*Emergency InformationEmergency Contact* First Last Phone*In case of emergency, Preferred Hospital In case of emergency, Preferred Physician In case of emergency, Preferred Dentist Payment InformationAre you an OHAC member?*OHAC MemberNon-MemberTotal $0.00 Payment Method Online Check If paying by check make payable to: Orchard Hills Athletic Club In memo indicate: Water Polo fees Mail to: P.O. Box 131277, Ann Arbor, MI 48113Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name