SCHOOL REGISTRATION

     
   You are registering for Pinecrest Academy South Charter School   
   Program: 14 Week Season starting January Friday 6, 2012   
   Practice day: Friday at 3:30 p.m. at the school's basketball court
   Program Fee:  $185.00   (Award & T-shirt included)

I am registering for *
BASKETBALL
Are you NEW player in Sports For Kids
YES NO
Name of the Child *
male *
Male
female *
Female
Date of Birth *
School *
Grade *
Father's name *
Phone Type
Phone Country
Cell Phone
W Phone Number *
Mother's Name *
Phone Type 1
Phone Country 1
Cell Ph Number *
W Ph Number
Home Address *
Phone Type 3
Phone Country 3
Home Ph Number *
Phone Extension 1
City *
ST *
Zip *
E-mail address *
Emergency contact name
Phone Type 2
Phone Country 2
Emergency Contact Phone Number *
Phone Extension
I have read and agree to the Parent Agreement and thePolicies *
I Agree
T-SHIRT SIZE *
PRINT NAME *
DATE *
Pick a date
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