Delaware City PAL Registration
Fill out the form carefully for registration
Confidentiality
Any confidential information requested is for our records and for the funding that our organization receives. The answers you provide will be kept completely confidential. By you providing of this information is both appreciated and necessary.
Member (Child's) Name
First Name
Middle Name
Last Name
Child's Birthdate
-
Month
-
Day
Year
Date
Child's Gender
Please Select
Male
Female
Non-Binary
Choose not to specify
Child's School
Race/ethnicity
Please Select
Caucasian
African American
Hispanic
Asian
other
Grade Levels
Please Select
Elementary School
Middle School
High School
College
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1 Name & Relation
Contact Number
Parent/Guardian 2 Name & Relation
Contact Number
Parent/Guardian 1 Email
Parent/Guardian 2 Email
Authorized pick up personnel (First and Last Names)
Is there any custody arrangements we should know about?
Please Select
No
Yes (please provide copy)
Do you have insurance
Please Select
No
Yes
Name of Insurance and Policy Number
Does your child have any allergies/medical problems/diagnosis? Please explain
Parent/Guardian Signature
I understand the rules of the PAL of DE and request that my son/daughter be admitted into membership. I have explained the rules to my son/daughter and agree that the PAL of DE will not be responsible for any accident to the boy/girl while on the PAL of DE premises or while engaged in any of its activities away from the PAL of DE. I give my consent for photographs, in which my son/daughter may appear, to be used in any PAL of DE may care to use them. I certify that my child is in good health and is amiable to normal discipline necessary for a successful group experience. I give my permission for PAL of DE to take my child for short trips on rainy days as part of programs. I/we do hereby, for services rendered, release the Police Athletic League of Delaware, Inc. and its employees and the Board of Directors from any and all liability. Disclaimer: The Police Athletic League of Delaware is a non-profit 501 3c Corporation. Consequently in order to receive federal/government regulated funding, we REQUIRE ALL information from the above application.
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