Pine Tree 2 Boys' Basketball Registration


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* asterisks mark required information

Applicant Profile
*First Name:
*Last Name:
*Address:
*City:
*State/Province:
If you are an international applicant (except Canada), leave the "State" field blank.
*Zip Code:
*Country:
*Daytime Telephone:
Evening Telephone:
Fax:
*E-mail:
Enter the name of the attendee
Tuition
 
Would like to room with:
There is a limited number of quads, most rooms are doubles or triples.
Participant's DOB, Age and Height:
Participant's School, Grade and Coach as of September 2012
Level expected to play at in 2012-2013 (varsity, JV, etc.)
Total :
 
Medical Coverage
Company Policy No.
Group No.

We have a staff of highly qualified trainers. If a participant is not feeling well or is injured, the trainer will give immediate medical assistance. If the injury requires further attention, we take the participant to Maine-General Medical Center at which time we contact the parent or legal guardian. THE PARENT OR LEGAL GUARDIAN IS RESPONSIBLE FOR ALL HOSPITAL, PRESCRIPTIONS, LABORATORY AND DOCTOR'S FEES. Please indicate above your insurance information.

Additional Comments
Please enter any additional comments that you think we should know about your registration including any food preferences or allergies we should be aware of (255 characters max).
Billing Information
*Amount to Pay Today:
Registration confirmation will be sent via e-mail.

Release of Liability

By submitting this form, you have read and agree to the Release of Liability