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To register and pay online please fill out the information below.
Fields marked with
*
are required.
***PRINT REGISTRATION FORM AND MAIL OR SIGN UP BELOW***
Printable Registration
PrimeTime Lacrosse
PO Box 57084
Babson Park, MA 02457
Registration Information
Participant Information
*
First Name:
*
Last Name:
*
Age:
*
Grade Entering in Fall 2008:
Select One
5th
6th
7th
8th
9th
10th
11th
12th
*
Date Of Birth:
*
Address Line 1:
Address Line 2:
*
City:
*
State:
*
Zip:
*
School:
*
Position:
*
T-Shirt Size:
Size
Small
Medium
Large
X-Large
XX-Large
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Experience:
Parent Info
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Parent Name 1:
Parent Name 2:
*
Telephone:
Telephone #2:
*
Email Address:
Emergency Contact Info
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Name:
*
Relationship:
*
Phone 1:
Phone 2:
Insurance Info
*
Health Insurance Company:
*
Insured Person Relationship to Participant:
*
Insurance Number:
Medical Issues or Allergies
General Info
How did you hear about PTL?
*
Please Check the session you are registering for:
2008 Fall Program:
Winter Pre-Season MetroWest ($185.00)
Winter Pre-Season South Shore ($185.00)
By clicking the submit button below I realize that I am registering the player named above for the camps selected, and that all payments are final and non-refundable, unless cancellation is due to a health related emergency, in which case a refund, less deposit, may be processed with a note from a medical doctor, and that there are no refunds after September 20th, 2008. I also attest that all of the information above is accurate and that the cardholder of the credit card listed above has full knowledge that this payment is being made.
*All sales are final after July 13th, 2008.*
PrimeTime Lacrosse
PO Box 57084
Babson Park, MA
02457
Fax:781-239-3996