if interested please fill out the following information and send to Kelly Huber. 4 Hyacinth Dr. Westford MA, 01886.
REGISTRATION INFORMATION
Name__________________________________________________
Find out what's happening in Westfordfor free with the latest updates from Patch.
Address________________________________________________
_______________________________________________________
Find out what's happening in Westfordfor free with the latest updates from Patch.
Home Phone ( ) _______________________________________
Parent Email____________________________________________
Emergency Contact ________________________________________
Cell/Emer. Contact # ( ) __________________________________
Date of Birth _____________________________________________
Grade/School _____________________________________________
In case of any injury the parents insurance would be the primary insurance coverage.
Insurance Co. _____________________________________________
Policy # __________________________________________________
(Consent release in case of injury or illness)
Signature of Parent or Guardian: ____________________________________