Summer Flag Football

Child's Name(Required)

First Last

Age(Required)

Date of Birth(Required)

School(Required)

Grade(Required)

Email(Required)

Enter Email Confirm Email

Home Phone(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian(Required)

First Last

Relationship(Required)

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Hospitalization Plan:

Policy #:

Allergies:

Doctor(Required)

Doctors Telephone:(Required)

Birth Certificate(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 GB.

Signature(Required)

I/WE, the Parents or guardians of the above named candidate for a position on the Albany Police Athletic League Inc. (PAL), hereby give my/our approval for our child to participate in any and all PAL activities. I/we know that participation in PAL activities may result in serious injury, and that protective equipment does not prevent all injuries to players and/or participants, and I/we do hereby waive, release, absolve, indemnify and agree to hold harmless the Albany Police Athletic League, PAL Board members, National PAL, organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or any other cause. I/we do hereby give permission for my child to receive medical treatment in case of an emergency if I/we cannot be contacted. I/We do hereby give permission for my/our child's photo likeness to be used in any and all PAL promotional literature.

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