Registration
To register for our Summer Fundamentals program at ECE Central (in Lancaster, MA), please complete the following information. Weekly practice times will be determined by late May. Practices will be held for 12 weeks, June-August. A calendar of practices will be provided once day/time are determined. Please note that completion of this registration is to sign-up for the program. Additional documentation MAY BE required prior to the start of the season.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Athlete's age as of 6/1/2021*
Athlete's t-shirt size (Youth S-Youth XL; Adult S-Adult XXL)*
Emergency Contact Name
Emergency Contact Phone Number
Allergies, Medications, or Medical Conditions?
 
Additional Information:
 
RELEASE & INDEMNITY
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I've read the above and agree.
 
MEDICAL ATTENTION
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I've read the above and agree.
 
PICTURE/NAME PERMISSION
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I've read the above and agree.
 
VIRTUAL INSTRUCTION
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I've read the above and agree.
 
Covid-19 Assumption of Risk
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*