Pinellas Police Athletic League | Landings Summer 2022

Pinellas Sheriff's Police Athletic League The Landings Summer 2022 Registration

* If there is a registration field that you do not have the ability to answer, please fill in "N/A" for our records.
CHILD'S ENROLLMENT RECORD
Name *

First Name Middle Name Last Name
Nickname *
Date of Birth *

Month Day Year
Date
Sex *
Gender *
Race *
Ethnicity *
Does your child speak a language at home besides English?
If yes, which language?

Spanish Other
Child's Relationship to Head of Household *
Which School will your child be attending Fall 2022/Spring 2023? *

Rawlings Elementary School The Broach School New Heights Elementary School Blanton Elementary School Alfred Adler School Plato Academy Other
Student Number *
00-0000000. Please contact your child's school to get their school number. (Example: Pinellas County Schools is a 10-digit ID, The Broach School is a 4-digit ID) From some kids, this number is found on their report cards or progress reports, for others it is found in their portal or is the password to their portal access.
What grade are they in this year Fall 2022/Spring 2023? *
Primary Hours of Care
From *
Please type 8:00 AM
To *
Please type 6:00 PM
Days of Week in Care *
Please type M-F
Child's Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Family Information
Child Lives with *
Parent’s 1 Name *
Address (Parent 1) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
The Best Email to Send You Notifications *
example@example.com
Home Phone (Parent 1) *
Employer (Parent 1) *
Employer Address (Parent 1) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 1 Work Phone *
Parent 1 Cell Phone *
Custody *

Mother Father Both Other
Name *
Parent’s 2 Name *
Address (Parent 2) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone (Parent 2) *
Employer (Parent 2) *
Employer Address (Parent 2) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 2 Work Phone *
Parent 2 Cell Phone *

Food Experience Permission Form
I give permission for my child First and Last Name* to participate in food-related activities.
Please check one of the following: *

My child DOES NOT have a food allergy or dietary restriction. My child DOES have a food allergy or dietary restriction. He or she MAY NOT participate in activities. My child DOES have a food allergy or dietary restriction. He or she may participate, but may not eat or handle the following items (please list below)
Signature *

Clear
Date *

Month Day Year
Date

Emergency Contacts:

Please tell Pinellas PAL who to contact when you cannot be reached. Your child/ren will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the children’s center in case of illness, accident or emergency, if for some reason the custodial parent(s) or legal guardian(s) cannot be reached:
Name *
Relationship to the Participant *
Home Phone *
Cell Phone *
Address *
Street Address (Number, Apartment, etc.), State, Zip Code
Name *
Relationship to the Participant *
Home Phone *
Cell Phone *
Address *
Street Address (Number, Apartment, etc.), State, Zip Code
Street Address (number, apartment #, street)
Please use additional sheet of paper to list name, address and phone number of any other people authorized to pick the child up.
Medical Information:
Child's Physician/Health Resource *
Telephone Number *
Address *
Street Address (Number, Apartment, etc.), State, Zip Code
Hospital Preference *
Name of Dentist *
Dentist's Telephone *
Dentist's Address *
Street Address (Number, Apartment, etc.), State, Zip Code
Meals typically served while in care (Please select both): *

PM Snack Supper
Emergency Care Plan instructions (if applicable) *
Miscellaneous Information
List all known allergies *
List all identifying scars, birthmarks, skin discolorations *
Special medical or dietary needs of child *
List any areas of concern *
My signature below verifies that:

I give permission to consult the child's physician/health resource listed above in case of emergency if parent/legal guardian cannot be reached.

I have received a copy of the "Know Your Child's Children's Center" brochure.

I was notified in writing of the disciplinary and expulsion policies used by the children's center.

I was provided the food and nutrition policies used by the children's center.

Your signature below indicates that you have received the above items and that the information on this enrollment form is complete and accurate. I hereby grant permission for the staff of this facility to have access to my child's records.
Signature *

Clear
Date *

Month Day Year
Date

EMERGENCY MEDICAL RELEASE

This form must contain only one child’s name, and be the original notarized form. A new notarized form is required when there is a change in legal guardianship.
Child’s Full Name *
First, Middle, Last Name
Birthdate *

Month Day Year
Date
Allergies *
Please separate with commas (i.e. peanuts, shellfish)
Medicines Routinely Taken *
Please separate with commas (i.e. Tylenol, etc.)
Name of Custodial Parent(s)/Legal Guardian(s) *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Telephone *
Cell Telephone *
Work Telephone *
Family Physician’s Name/Health Care Resource *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone *

Area Code Phone Number
Hospital Preference *
Medical Insurance Company *
Policy # *
Expiration Date *

Month Day Year
Date
Emergency Contact (if custodial parent/guardian cannot be reached) *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Telephone *
Cell Telephone *
Work Telephone *

Influenza Virus - Information

During the 2009 legislative session, a new law was passed that requires child care facilities, family day care homes and large family child care homes provide parents with information detailing the causes, symptoms, and transmission of the influenza virus (the flu) every year during August and September.
What is the influenza (flu) virus?

Influenza ("the flu") is caused by a virus which infects the nose, throat, and lungs. According to the US Center for Disease Control and Prevention (CDC), the flu is more dangerous than the common cold for children. Unlike the common cold, the flu can cause severe illness and life-threatening complications in many people. Children under 5 who have the flu commonly need medical care. Severe flu complications are most common in children younger than 2 years old. Flu season can begin as early as October and last as May.

How can I tell if my child has a cold, or the flu?

Most people with the flu feel tired and have fever, headache, dry cough, sore throat, runny or stuffy nose and sore muscles. Some people, especially children may also have stomach problems and diarrhea. Becasue the flu and colds have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

What should I do if my child gets sick?

Consult your doctor and make sure your child gets plenty of rest and drinks a lot of fluids. Never give aspirin or medicine that has aspirin in it to children or teenagers who may have the flu.

CALL OR TAKE YOUR CHILD TO A DOCTOR RIGHT AWAY IF YOUR CHILD:
- Has a high fever or fever that lasts a long time
- Has trouble breathing or breathes fast
- Has skin that looks blue
- Is not drinking enough
- Seems confused, will not wake up, does not want to be held, or has seizures (uncontrolled shaking)
- Gets better but then worse again
- Has other conditions (like heart or lung disease, diabetes) that get worse
How can I protect my child from the flu?

A flu vaccine is the best way to protect against the flu. Because the flu virus changes year to year, annual vaccination against the flu is recommended. The CDC recommends that all children from ages up to 6 months up to their 19th birthday receive a flu vaccine every fall or winter (children receiving a vaccine for the first time require two doses). You can also protect your child by receiving a flu vaccine yourself.

What can I do to prevent the spread of germs?

The main way that the flu spreads is in respiratory droplets from coughing and sneezing. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and infect someone nearby. Though much less frequent, the flu may also spread through indirect contact with contaminated hands and articles soiled with nose and throat secretions. To prevent the spread of germs:
- Wash hands often with soap and water.
- Cover mouth/nose during coughs and sneezes. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
- Limit contact with people who show signs of illness.
- Keep hands away from the face. Germs are often spread when a person touches his or her eyes, nose, or mouth.
When should my child stay home from child care?

A person may be contagious and able to spread the virus from 1 day before showing symptoms to up to 5 days after getting sick. The time frame could be longer in children and in people who don't fight disease well (people with weakened immune systems). When sick, your child should stay at home to rest and to avoid giving the flu to other children and should not return to child care or other group setting until his or her temperature has been normal and has been sign and symptom-free for a period of 24 hours.

My signature below verifies receipt of the brochure on Influenza Virus, The Flu, A Guide to Parents:
Parent/Guardian Name *

First Name Last Name
Child's Name *

First Name Last Name
Date Received *

Month Day Year
Date
Signature *

Clear

Distracted Adult Form

When Life Happens...Don't be a Distracted Adult
A change in daily routine, lack of sleep, stress, fatigue, cell phone use, and simple distractions are some things parents experience and can be contributing factors as to why children have been left unknowingly in vehicles...

Facts About Heatstroke:

It only takes a car 10 minutes to heat up 20 degrees and become deadly.

Even with a window cracked, the temperature inside a vehicle can cause heatstroke.

The body temperature of a child increases 3 to 5 times faster than an adult's body.

Prevention tips:
- Never leave your child alone in a car and call 911 if you see any child locked in a car!
- Make a habit of checking the front and back seat of the car before you walk away.
- Be especially mindful during hectic or busy times, schedule or route changes, and periods of emotional stress or chaos.
- Create reminders by putting something in the back seat that you will need at work, school or home such as a briefcase, purse, cell phone or your left shoe.
- Keep a stuffed animal in the baby's car seat and place it on the front seat as a reminder when the baby is in the back seat.
- Set a calendar reminder on your electronic device to make sure you dropped your child off at child care.
- Make it a routine to always notify your child's child care provider in advance if your child is going to be late or absent; ask them to contact you if your child hasn't arrived as scheduled.
During the 2018 legislative session, a new law was passed that requires child care facilities, family day care homes and large family child care homes to provide parents, during the months of April and September each year, with information regarding the potential for distracted adults to fail to drop off a child at the facility/home and instead leave them in the adult's vehicle upon arrival at the adult's destination.

My signature below verifies receipt of the Distracted Adult Brochure.
Parent/Guardian *

Clear
Child's Name *

First Name Last Name
Date *

Month Day Year
Date

Acknowledgement of Risks and Waiver of Liability Relating to Coronavirus/COVID-19

PAL Form
I acknowledge that on or about March 11, 2020, Coronavirus Disease 2019 (“COVID-19”) was declared a pandemic by the World Health Organization. The Centers for Disease Control and Prevention (“CDC”) has stated that “the best way to prevent illness is to avoid being exposed to this virus.” https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html.

I am aware of the contagious nature of COVID-19 and have voluntarily chosen to allow my child(ren) to participate in programs operated by Pinellas Sheriff’s Police Athletic League, Inc. (“Pinellas PAL

I acknowledge that Pinellas PAL employees come into contact with multiple individuals and might become exposed to COVID-19. I also acknowledge that although Pinellas PAL takes precautions to reduce the likelihood of transmission of COVID-19 by its employees, it cannot guarantee that my child(ren) will not become infected with COVID-19.

I knowingly acknowledge that by allowing my child(ren) to participate in Pinellas PAL’s programs. I am exposing my child(ren) and myself to the risk of becoming infected with COVID-19, which may result in serious personal injury, illness, permanent disability, and death. I understand the risk of becoming exposed to or infected by COVID-19 may result from actions, negligence, and failures to act of myself and others, including, but not limited to, Pinellas PAL employees, and other program participants and parents.

I agree to assume all of the foregoing risks, and accept personal responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability or expense, of any kind or nature, that I may suffer arising out of or in connection with my child(ren) or myself becoming exposed to or infected by COVID-19 while my child(ren) is/are participating in any Pinellas PAL program. On my own behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, and forever discharge Pinellas PAL, its employees, agents, and representative, of and from all liabilities, claims, actions, damages, costs or expenses of any nature (“Claims”) arising out of or in any way connected with my child(ren) or myself becoming exposed to or infected by COVID-19. I understand that this release includes any Claims based on the negligence, action, or inaction of any of Pinellas PAL, its employees, agents, and representatives, and covers bodily injury (including death) due to COVID-19, whether a COVID-19 infection occurs before, during or after participation in any Pinellas PAL program.
Parent or Guardian's Signature *

Clear
Date *

Month Day Year
Date
Parent or Guardian's Name Printed *

First Name Last Name
Child's Name *

First Name Last Name

Participant Release Information

Please select one of the statements below based on your child's ability or lack there of to walk home.
I, parent/guardian of my child ___________ him/her to walk home alone at the end of the program day. *

ALLOW. I understand that if I need my child earlier than end of day, I will contact the office to request his/her early dismissal. DO NOT ALLOW. I understand that I must pick up my child and/or arrange someone from the escort list below to pick my child up by the end of program day.
Parent Signature *

Clear
Date *

Month Day Year
Date
Family Information
Parent/Guardian 1 *

First Name Last Name
Relationship *
Phone Number *
Please enter a valid phone number.
Parent/Guardian 2 *

First Name Last Name
Relationship *
Phone Number *
Please enter a valid phone number.
Sibling/housemate in program:
Name: First Name Last Name Relationship: blank Age:
Sibling/housemate in program:
Name: First Name Last Name Relationship: blank Age:
Sibling/housemate in program:
Name: First Name Last Name Relationship: blank Age:
Sibling/housemate in program:
Name: First Name Last Name Relationship: blank Age:
Emergency Release and Escort List
As the parent of First Name* Last Name* , I authorize the emergency release and/or pickup of my child by the following adults, over the age of 18, listed below. I understand appropriate ID will be required for each person that picks up my child. Furthermore, I authorize Pinellas PAL to contact these individuals in case of an emergency when I, or another parent or guardian, cannot be reached.
1. Name: First Name * Last Name * Relationship: * Phone #: Area Code * Phone Number *
1. Name: First Name * Last Name * Relationship: * Phone #: Area Code * Phone Number *
1. Name: First Name * Last Name * Relationship: * Phone #: Area Code * Phone Number *
1. Name: First Name * Last Name * Relationship: * Phone #: Area Code * Phone Number *
IMPORTANT! (If this applies to you and your child) *

I DO NOT authorize the release of my child to the individual(s) listed below due to a court ordered custody agreement/order or protection. I understand I may be asked to provide official documentation proving such order(s).
*

Authorization and Consent for Disclosure, Receipt, and Use of Confidential Information by the Juvenile Welfare Board of Pinellas County
I, First and Last Name* (print participant name(s)) acknowledge that I am a participant of Pinellas Sheriff's PAL. I acknowledge that the Juvenile Welfare Board of Pinellas County (“JWB”) provides funds to make the program or service in which I am participating available. I also acknowledge that in order to make sure that all services delivered to participants are of the highest possible quality, JWB may need to review information about me and these services.
By signing this Authorization, I am indicating that I understand and agree that my confidential information may be contained in a JWB data collection system and that this data collection system is exempt from disclosure under the Florida Public Records Act. This means that by law, JWB cannot release individually identifiable information about me or the services I receive (Fla. Stat. §119.071 I acknowledge that as necessary to carry out the purposes listed herein, JWB may review all information about me, including my participant file and all other information pertaining to me held by the agency providing the program or service, regardless of whether that information is entered into a JWB data collection system. I further acknowledge that JWB is simply storing and reviewing records and information as the payor for these services, and that JWB generally provides no direct services to me, except in certain circumstances may facilitate service delivery I further acknowledge that JWB does not provide medical diagnoses to me and JWB is not a covered entity as that term is defined under HIPAA (the Health Insurance Portability and Accountability Act).
I authorize JWB to utilize my confidential information to verify eligibility for funded services or programs, to facilitate service delivery, make payment for services rendered to me by funded programs or services, quality control of funded services or programs, evidence-based research of JWB funded services or programs, including, but not limited to, tracking outcomes of funded programs and services, and determination of future services/programs funded by JWB. I understand that the confidential information disclosed, received or used by JWB related to my Authorization will not be further disclosed to any other party without my express written consent or as otherwise permitted or required by applicable law unless it is presented in a report that presents information on a group of individuals in de-identified format, which means that no information that identifies me as an individual is revealed.
I acknowledge that this Authorization covers all information about me including, but not limited to, personally identifiable information, Protected Health Information, general medical, general counseling, as well as psychiatric/ psychological/ substance abuse information from my medical health record, any information concerning the performance of any tests, results of those tests, and counseling and treatment records, as allowed by all state, federal and local laws, including, but not limited to the following: Florida Statutes 394.459, 381.004, and 395.3025; Florida Evidence Code 90.503, 90.5035, and 90.5036; HIPAA, and the Code of Federal Regulations (CFR) Title 42. I consent to my minor participating in online or paper surveys that will be used for program improvements and enhancements. I understand that my records have a privileged and confidential status. I am waiving that status for the purposes contained by this Authorization.
I understand that the confidential information disclosed, received or used by JWB based on this Authorization will not be further disclosed to any other party without my express written consent or as otherwise permitted or required by applicable law. However, the individually identifiable confidential information received by JWB based on this Authorization may be used by JWB and its agents for research purposes, so long as the research results are reported as a whole in de-identified format, which means that no information that identifies me as an individual is revealed. Except, JWB will not provide any records covered by CFR Title 42 to any JWB agents. I understand that I have the right to withdraw my approval in writing at any time. However, it is possible that JWB may have already relied on this Authorization before it receives notice of my withdrawal and that JWB may have already taken action based on the Authorization. If I do not withdraw my approval, it will automatically end one (1) year from the last day I received services from this program, or with respect to information used in research, or for compliance and quality review activities performed by JWB or its agents, upon completion of the last research project or compliance/ quality review, whatever occurs latest. By my signature below, I acknowledge that I have given my consent as indicated above freely, voluntarily, and without coercion, and that I have been given a copy of this authorization, signed by me on the date shown below.

PAL 2021-22 After School Student Expectations
By attending Pinellas PAL as a participant, you agree to:
1. Follow all PAL rules, regardless of age.
2. Check-in and out of PAL.
3. Stay at PAL until you’re ready to leave. There is no coming and going—once you leave, you leave for the day.
4. Respect and listen to all PAL staff. This means you will not raise your voice to staff, argue with them, or cause any inappropriate conflicts.
5. Respect other PAL participants and their belongings. Theft of property will result in an automatic suspension.
6. Demonstrate good behavior and manners at ALL times.
7. Wear close-toed shoes at ALL times.
8. Take responsibility for all money and/or belongings you bring to PAL.
9. Refrain from fighting, wrestling, bullying, or any other violent/hurtful contact with other PAL members or staff. Fighting staff/students on PAL property will result in an automatic suspension.
10. Respect PAL property by using things as they are meant to be used and refraining from damaging or destroying property.
11. Stay with your assigned group at all times.
12. Stay in your seat the entire time you are riding on PAL vehicles—no standing or horseplay.
13. Refrain from contacting PAL staff outside of PAL.
14. Keep your cell phone in your locker and only use it in approved and necessary situations.
15. Eat any food provided in the designated areas, clean up after yourself, and wash your hands before and after eating.
16. Dress for PAL according to the dress code at your school.
17. Submit all report cards/progress reports to a PAL coach so they may make a copy.
Pinellas PAL continues to review our safety standards in relation to the COVID-19 pandemic based on guidelines set by the CDC. We will keep participants and their families informed of all practices and any changes to our protocol. By attending PAL, you agree to cooperate with all safety standards set in place by PAL with the intent to mitigate the spread of COVID-19.
Participant Signature *

Clear
Date *

Month Day Year
Date

PAL 2021-22 School Year Parent Expectations
By enrolling your child(ren) at Pinellas PAL, you agree to comply with all PAL
expectations and requirements of participation. Specifically, you agree to:
1. Follow all PAL rules and hold your child accountable for following the rules.
2. Pick up your child before PAL closes at 6:00 PM.
3. Check your child(ren) out of PAL when you pick them up.
4. Complete all necessary paperwork and provide all required information,
  documentation, etc. in a timely manner.
5. Adhere to PAL attendance requirements.
6. Pick up your child (or arrange for pick up) in a timely manner if they are sick,
  breaking the rules, or have been suspended from PAL.
7. Keep your child(ren) at home if they show symptoms of communicable illness,
  food poisoning, lice, etc. for at least 24 hours after their symptoms have
  disappeared.
8. Treat PAL staff and other participants with respect.
Pinellas PAL continues to review our safety standards in relation to the COVID-19
pandemic based on guidelines set by the CDC. We will keep participants and their
families informed of all practices and any changes to our protocol. By enrolling your
child in PAL, you agree to cooperate with all safety standards set in place by PAL with
the intent to mitigate the spread of COVID-19.
Parent Signature *

Clear
Date *

Month Day Year
Date

Permissions
In consideration for PCSO PAL permitting my child to participate in this program, I release the Pinellas County Sheriff’s Police Athletic League, and the Pinellas County Sheriff’s Office, deputies, members, employees, activity coordinators, and any volunteer specifically authorized by PCSO to supervise PAL activities from all rights, claims and damages for the negligent actions of any PCSO member arising out of this participation. In signing this document I understand that I am releasing or giving up certain potential legal rights and I further acknowledge that I have been advised that I may wish to seek the advice of legal counsel prior to signing this document. Being so informed, I knowingly and voluntarily execute this release and waiver as evidenced by my signature on the last page of this agreement. *

Agree
In case of an emergency involving my child, I understand every effort will be made to contact the child’s parent(s) or legal guardian. In the event they cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child, until such time as I can be contacted. Also until such time as I can be contacted, I give my permission for medical providers to disclose to the adult in charge the information needed to make an informed decision, including but not limited to disclosing the results of any examination findings, test results, and/or treatment. *

Agree
Transportation: I give permission for PAL to transport my child to activities that are off PAL property. *

Agree
Photo Release: I hereby grant PAL the right and permission to use photographs and/or video recordings of my child with or without my child's name on PAL and other websites and in publications, promotional flyers, materials, derivative works, or for any other similar purpose. *

Agree
Photo Release: I hereby grant JWB the right and permission to use photographs and/or video recordings of my child with or without my child's name on JWB and other websites and in publications, promotional flyers, materials, derivative works, or for any other similar purpose. *

Agree
Skate Park Guidelines - I understand that: All skaters MUST register at the PAL Lealman Sports Complex BEFORE entering the skate park. Skaters must be at least 8 years of age. Skaters under the age of 18 years must have a Pinellas County Sheriff’s Police Athletic League waiver signed by their parent or legal guardian, and the waiver must be notarized before entering the skate park for the first time. Skaters under the age of 12 must have a parent/guardian with them at ALL TIMES while in the skate park. SKATE AT YOUR OWN RISK, keeping in mind your safety and that of others. Pinellas PAL does not assume responsibility for injuries. Safety helmets and shirts must be worn at all times. Elbow pads and knee pads are highly recommended. No pets, food (including gum and candy), beverages, alcohol, drugs, smoking, cookers, backpacks, or boom boxes are allowed in the skate park. Do not deposit any trash, debris, or other objects on the skating surface. Promptly report any observed damage to the skate park to staff. Reckless/improper behavior and abusive/profane language will not be tolerated. Due to safety concerns, spectators must remain outside of the fenced-in skate park area. Skaters not observing the above noted rules and regulations may be asked to leave the facility and may lose their skating privileges for a prescribed period of time. Pinellas PAL reserves the right to close this park at any time in the event of inclement weather, wet surfaces, damaged facilities, or other unsafe conditions. Anyone caught in the skate park during closed hours will be subject to trespass infractions as well as suspension from park privileges. *

Agree
Attendance: The Pinellas Sheriff’s Police Athletic League’s after school program has transitioned its focus towards academics. Every child is expected to spend time working on academics in our learning labs. To maintain the grants that fund PAL, we are required to track your child's academic progress using their Portal access and report cards. When you sign up for the PAL program, you agree that your child will be present at least 70% of the time. This means you should be at our facility a minimum of 14 days of the month, it's important your child attends and signs in and out from PAL. *

Agree
Lost/Stolen Items: If you bring cell phones, electronic devices, or anything of value, you are responsible for them while you are here on Pinellas Sheriff’s Police Athletic League property or on any field trips. If the item or items become missing, it is your responsibility. We are not responsible for your valuables. Participants are invited to bring their cellphones at PAL. We ask that cellphones not be used during any group or classroom activities and only to contact parents/guardians if needed. A cellphone is the participant’s personal property and will be treated that way. PAL employees have the right to take a cellphone away from a child and return it to their parents when they get picked up. Cellphones are the most likely items to go missing at a school, sport event, or afterschool activity. They are small and valuable. Every PAL participant is offered a locker to store their personal belongings. PAL is not responsible for participant’s personal belongings. If your child brings a cellphone to PAL, lays it down to play, leaves it to charge, lets someone else use it, or stops carrying it with you and it disappears, it is their fault. They must put them in their assigned locker. PAL is NOT responsible for items left unattended. *

Agree
Signature *

Clear

Pinellas Sheriff's Police Athletic League The Landings Summer 2022 Registration

CHILD'S ENROLLMENT RECORD

Primary Hours of Care

Family Information

Food Experience Permission Form

Emergency Contacts:

Medical Information:

Miscellaneous Information

EMERGENCY MEDICAL RELEASE

Influenza Virus - Information

Distracted Adult Form

Acknowledgement of Risks and Waiver of Liability Relating to Coronavirus/COVID-19

Participant Release Information

Family Information

Emergency Release and Escort List

Authorization and Consent for Disclosure, Receipt, and Use of Confidential Information by the Juvenile Welfare Board of Pinellas County

PAL 2021-22 After School Student Expectations

PAL 2021-22 School Year Parent Expectations

Permissions

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