Marietta PAL 2025-26 After School Programs Registration Form

Marietta PAL 2025-26 After School Registration Form

Please complete registration for PAL After School programs August 2025 - May 2026. If applying for scholarship approval, please make sure you have: Drivers licenses, proof of Marietta residency & income documents ready for uploading. Scholarships are limited, first come first served. *Please note - MARTIAL ARTS classes are CURRENTLY FULL - YOU MAY EMAIL dbadio@mariettaga.gov. Subject: Please Add to Martial Arts Wait List.
Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's E-mail*
example@example.com
Mobile Phone Number*
Relationship to Child*

ParentGrandparentGuardianOther
Marital Status*

SingleMarriedDivorcedSeparated
Employer*
Work Number*
Does your child(ren) qualify for free or reduced lunch?*

YesNo
How many children are you registering for Marietta PAL programs?*

12345
Child 1 Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child 1's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
If Other, please enter School Name
For which Programs are you registering Child 1? Cost is $100 per program per semester (Fall/Winter Semester: Aug-Dec 2025; Winter/Spring Semester: Jan-May 2026)*

Afterschool, K-12th grade, Mon - Fri, 3-6pmBoxing, 12-17 yrs old, Tue & Thu, 6-8pmCLOSED - CLASS IS FULL - Martial Arts, 5-16 yrs old, Tue & Thu, 5:30-8pmDance, 5-17 yrs old, Mon & Wed, 6-8pmTheater, 11-17 yrs old, Mon & Wed, 6-8pmBaseball, 8--12 yrs old, Fridays, 6-7:30pm ($50)
Marietta PAL requires 85% attendance for your child's agreed upon schedule. Will your child attend programming at least 85% as scheduled?*

YesNo
Child 1 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, learning disabilities, allergies of any kind, or other medical condition PAL should be aware of?*
Child 2 Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child 2's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
If Other, please enter School Name
For which Programs are you registering Child 2? Cost is $100 per program per semester (Fall/Winter Semester: Aug-Dec 2025; Winter/Spring Semester: Jan-May 2026)*

Afterschool, K-12th grade, Mon - Fri, 3-6pmBoxing, 12-17 yrs old, Tue & Thu, 6-8pmCLOSED - CLASS IS FULL - Martial Arts, 5-16 yrs old, Tue & Thu, 5:30-8pmDance, 5-17 yrs old, Mon & Wed, 6-8pmTheater, 11-17 yrs old, Mon & Wed, 6-8pmBaseball, 8--12 yrs old, Fridays, 6-7:30pm ($50)
Marietta PAL requires 85% attendance for your child's agreed upon schedule. Will your child attend PAL Afterschool daily - Monday through Friday?*

YesNo
Child 2 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, learning disabilities, allergies of any kind, or other medical condition PAL should be aware of?*
Child 3 Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child 3's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
If Other, please enter School Name
For which Programs are you registering Child 3? Cost is $100 per program per semester (Fall/Winter Semester: Aug-Dec 2025; Winter/Spring Semester: Jan-May 2026)*

Afterschool, K-12th grade, Mon - Fri, 3-6pmBoxing, 12-17 yrs old, Tue & Thu, 6-8pmCLOSED - CLASS IS FULL - Martial Arts, 5-16 yrs old, Tue & Thu, 5:30-8pmDance, 5-17 yrs old, Mon & Wed, 6-8pmTheater, 11-17 yrs old, Mon & Wed, 6-8pmBaseball, 8--12 yrs old, Fridays, 6-7:30pm ($50)
Marietta PAL requires 85% attendance for your child's agreed upon schedule. Will your child attend PAL Afterschool daily - Monday through Friday?*

YesNo
Child 3 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, learning disabilities, allergies of any kind, or other medical condition PAL should be aware of?*
Child 4 Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child 4's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
If Other, please enter School Name
For which Programs are you registering Child 4? Cost is $100 per program per semester (Fall/Winter Semester: Aug-Dec 2025; Winter/Spring Semester: Jan-May 2026)*

Afterschool, K-12th grade, Mon - Fri, 3-6pmBoxing, 12-17 yrs old, Tue & Thu, 6-8pmCLOSED - CLASS IS FULL - Martial Arts, 5-16 yrs old, Tue & Thu, 5:30-8pmDance, 5-17 yrs old, Mon & Wed, 6-8pmTheater, 11-17 yrs old, Mon & Wed, 6-8pmBaseball, 8--12 yrs old, Fridays, 6-7:30pm ($50)
Marietta PAL requires 85% attendance for your child's agreed upon schedule. Will your child attend PAL Afterschool daily - Monday through Friday?*

YesNo
Child 4 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, learning disabilities, allergies of any kind, or other medical condition PAL should be aware of?*
Child 5 Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child 5's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
If Other, please enter School Name
For which Programs are you registering Child 5? Cost is $100 per program per semester (Fall/Winter Semester: Aug-Dec 2025; Winter/Spring Semester: Jan-May 2026)*

Afterschool, K-12th grade, Mon - Fri, 3-6pmBoxing, 12-17 yrs old, Tue & Thu, 6-8pmCLOSED - CLASS IS FULL - Martial Arts, 5-16 yrs old, Tue & Thu, 5:30-8pmDance, 5-17 yrs old, Mon & Wed, 6-8pmTheater, 11-17 yrs old, Mon & Wed, 6-8pmBaseball, 8--12 yrs old, Fridays, 6-7:30pm ($50)
Marietta PAL requires 85% attendance for your child's agreed upon schedule. Will your child attend PAL Afterschool daily - Monday through Friday?*

YesNo
Child 5 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, learning disabilities, allergies of any kind, or other medical condition PAL should be aware of?*
Emergency Contact and Person Authorized to pick-up your child #1 of 2 - PLEASE ENTER CONTACT PERSON'S NAME & PHONE NUMBER*

First NameLast Name
Emergency Contact Phone Number #1 of 2*
Please enter a valid phone number.
Emergency Contact and Person Authorized to pick-up your child #2 of 2 - PLEASE ENTER CONTACT PERSON'S NAME & PHONE NUMBER*

First NameLast Name
Emergency Contact Phone Number #2 of 2*
Please enter a valid phone number.
Are you applying for a Program Scholarship available for City of Marietta “INCOME ELIGIBLE” participants. If approved, scholarship will cover the cost of one program per child.*

YesNo
Please enter TOTAL number of CHILDREN for which you're applying for a scholarship?*

12345
If applying for Program Scholarship, please list number of people living in your household?*

2345678
To apply for a Program Scholarship, please upload the following documentation:

PLEASE UPLOAD YOUR DOCUMENTS BELOW...

1. Upload proof of City of Marietta Address

2. Upload copies of Photo Identifications for all adults in household

3. Upload Verification of 2 months of ALL household INCOME (Pay stubs and/or government assistance if applicable)
File Upload*

Cancelof
If applying for a Program Scholarship, please remember your child(ren) can start programming immediately!

You will receive a temporary credit at checkout, pending final approval of your scholarship request. If you do not provide the complete documentation requested or are not approved for this scholarship, you will receive an invoice for the outstanding program fees within two weeks of today's date.

To receive your scholarship discount for 1 child, at checkout please enter Coupon Code: PALONE
If applying for a Program Scholarship, please remember your child(ren) can start programming immediately!

You will receive a temporary credit at checkout, pending final approval of your scholarship request. If you do not provide the complete documentation requested or are not approved for this scholarship, you will receive an invoice for the outstanding program fees within two weeks of today's date.

To receive your temporary discount for 2 children, at checkout please enter Coupon Code: TWO4PAL
If applying for a Program Scholarship, please remember you child can start programming immediately!

You will receive a temporary credit at checkout, pending final approval of your scholarship request. If you do not provide the complete documentation requested or are not approved for this scholarship, you will receive an invoice for the outstanding program fees within two weeks of today's date.

To receive your scholarship discount for 3 children, at checkout please enter Coupon Code: PAL4THREE
If applying for a Program Scholarship, please remember you child can start programming immediately!

You will receive a temporary credit at checkout, pending final approval of your scholarship request. If you do not provide the complete documentation requested or are not approved for this scholarship, you will receive an invoice for the outstanding program fees within two weeks of today's date.

To receive your scholarship discount for 4 children, at checkout please enter Coupon Code: FOUR4PAL
If applying for a Program Scholarship, please remember your child(ren) can start programming immediately!

You will receive a temporary credit at checkout, pending final approval of your scholarship request. If you do not provide the complete documentation requested or are not approved for this scholarship, you will receive an invoice for the outstanding program fees within two weeks of today's date.

To receive your scholarship discount for 5 children, at checkout please enter Coupon Code: PAL24FIVE
Statement of Understanding and Program Policies - I give permission for my child to participate daily in the PAL Program as scheduled, as well as special events and field trips, including transportation. - I understand my child will participate in academic, leadership and life skills, character development, sports, recreational, and enrichment activities. - I also understand and give permission for my child to attend several field trips as a part of this program. - I understand that this is not a licensed program; however Marietta PAL does carry liability insurance. I acknowledge that PAL and its staff, board, partners, volunteers, and any individual acting as agents for PAL do not hold liability and will not be held responsible for medical, hospital, or other costs resulting from injuries that might occur by participating in program activities or in transportation to and from the place where activities are conducted. I also grant permission to the Marietta Police Athletic League to approve medical emergency transport and treatment of my child should it be deemed necessary. - I acknowledge that PAL does not discriminate on the basis of race, color, religion, national origin, age, disability, or gender in its employment practices or student programs. - I give permission for PAL. to use photos and images of my child and my child’s likeness for news and publicity purposes, and I waive all claims to compensation for such use. I further acknowledge that the photographs in question will be only those in which my child is participating in a PAL activity and the photograph is one that is taken by a PAL staff member or an individual or agent acting as an agent of PAL. - I agree to make sure my child attends regular programming and special events and acknowledge that he/she may miss no more than ten days each program session. I agree to call PAL staff to inform them if my child will not be in attendance. - I understand that failure to comply with these attendance requirements could result in disenrollment. - I agree to pick up my child at the time specified by PAL. I understand that I may be required to pay a late fee if I do not pick my child up on time. - I acknowledge that PAL staff will report suspected child abuse and neglect. - I acknowledge that my child will not be allowed to leave the facility without being escorted by the parent(s) or person authorized by the parent(s), or facility personnel. - I acknowledge that it is my responsibility to keep my child’s records current to reflect any significant changes as they occur (i.e. telephone numbers, emergency contacts, child’s health status, and dietary restrictions). - I have read, understand, and agree to abide by the Statement of Understanding and the Program Policies of PAL and to cooperate with PAL staff and PAL Partners accordingly.*

Please check that you have read and agree to the Marietta PAL Statement of Understanding and Program Policies noted above.
Please tell us how you heard about the Marietta Police Athletic League (PAL) programs.*

Current PAL participantReceived an email/flyer from child's schoolReceived an email from City of MariettaReferred by a FriendFrom Online PostFound on the internet, google, eventbrite, etc.Other

Marietta PAL Program Fees, flat rate paid per semester (August thru December) and (January thru May)*

PAL Afterschool (Mon-Fri, 3-6pm)

$100.00 Quantity

PAL Boxing (Tue & Thurs, 6-8pm)

$100.00 Quantity

CLOSED - PAL Martial Arts IS FULL(Tue & Thurs, 5:30-8pm) Email dbadio@mariettaga.gov to be added to Wait List

$100.00 Quantity

Martial Arts Boys Uniform

$30.00 Quantity

Martial Arts Girls Uniform

$25.00 Quantity

PAL Baseball

$50.00 Quantity

PAL Theater (Mon & Wed, 6-8pm)

$100.00 Quantity

PAL Dance (Mon & Wed, 6-8pm)

$100.00 Quantity

Enter coupon

Total

$0.00

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Date

MonthDayYear
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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
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Marietta PAL 2025-26 After School Registration Form

To receive your scholarship discount for 1 child, at checkout please enter Coupon Code: PALONE

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