Program Registration

Spring Camp

Summer Nights

Dorchester Elite Eagles

BWB Monthly Skate

Student/Athletes Name

First Name

Last Name

Date Of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian Name *

First Name

Last Name

Home Number *

(###)

###

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Cell Number *

(###)

###

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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ARRIVAL

DROP OFF

CAR POOL

WE WILL REQUIRE BWB TRANSPORTATION PROVIDER

DEPARTURE

PICK UP

CAR POOL

WE WILL REQUIRE BWB TRANSPORTATION PROVIDER

CARPOOL: THE FOLLOWING PEOPLE HAVE PERMISSION TO PICK-UP MY CHILD FOR TRANSPORTATION PURPOSES:

First Name

Last Name

Phone Number *

(###)

###

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