• General Membership Registration

    General Membership Registration

    3707 N. Market St, Wilmington, DE 19802

  • Student Information

  • Parent/Guardian Information #1

  • Parent/Guardian Information #2

  • Non-Parent/Guardian Emergency Contact Information

  • Medical Information/ Permission to Treat

  • I, * herby authorize emergency medical treatment for my child, * in the event I cannot be contacted to grant permission to treat. I understand that I will be financially responsible for the cost of such treatment.

  • *   

  •  - -
    Pick a Date

  • Outings and Activities Information

  • I, * herby grant permission to PALW for my child * to attend and participate in onsite and offsite trips and activities including but not limited to: swimming, skating, bowling, nature walks, neighborhood walks, and various sports.

    I also understand that my child will be transported by PALW vehicles when necessary.

  • *   

  •  - -
    Pick a Date

  • PARENT/GUARDIAN PERMISSION FOR SWIMMING AND WATER ACTIVITIES

  • My child, * ,has my permission to participate in any swimming activity/outing with the PALW Summer Camp. I understand my child will be under the supervision of PALW staff members on site and/or a certified lifeguard during any water activity.

  • *   

  •  - -
    Pick a Date

  • PARENT PERMISSION TO PHOTOGRAPH AND DISPLAY IMAGES

    Your child's photo may be displayed throughout the facility, on the website, PALW marketing materials, or on the PALW's social media pages. 

    By signing below, I hereby authorize PALW to photograph and display images of my child.  

  • *   

  •  - -
    Pick a Date

  • PLEASE READ

    I certify that my child is in good health and is able to withstand the normal physical activity necessary for a successful group exercise. I give permission for my child to participate in normal activities held at the PALW facility. I understand that I will be required to sign a permission slip for off-site activities.

    I give my consent for any photograph in which my child may appear to be used at the discretion of PALW. I understand that these photographs may appear in marketing and promotional materials. 

    I understand that all youth are subject to basic disciplinary action if rules are not followed. In the event that my child is not following the PALW rules and regulations, they may be disciplined in the form of a verbal warning and/or timeout from participation in activities. The consequences of continual offenses include being sent home and/or loss of PALW privileges on a temporary basis.

    I have explained the rules to my child and agree that the PALW will not be responsible for any accidents to my child while at PALW.

    I fully understand the nature of the PALW program and realize that there may be inherent risks involved as my child participates. Therefore, I hereby release the PALW and its employees, volunteers, and BOD from any and all liability for damages accuring as a result of any accident or injury that may occur. 

     

    ***By signing below, I acknowledge that I have read and agree to the terms and conditions listed above.***

  • *   

  •  - -
    Pick a Date

  • Ethnicity:

    The office of Management and Budget (OMB) requires the collection of the following data on race, ethnicity, and income for purpose, programs, and civil rights compliance reporting. Thank you for your cooperation. 

  • Should be Empty: