Clone of Marietta PAL 2025 Summer Programs Registration Form

Marietta PAL 2026 Summer Camp Registration Form

Please complete registration for PAL Summer Camp programs June 1st - July 10, 2026.
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(ren)*

ParentGrandparentGuardianOther
Marital Status*

SingleMarriedDivorcedSeparated
Employer*
Work Number*
How many children are you registering for Marietta PAL Summer programs?*

12345
Child 1 Name*

First NameLast Name
Child's Age*
Child's Gender*
Child's Shirt Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Child 1's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
For which Programs are you registering Child 1?*

Summer Camp, K-12th grade, Mon - Fri, 8am-6pm ($25 Registration + weekly fee)Summer Boxing, 12-17 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)Summer Martial Arts, 5-16 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)
Child 1 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level (2025-2026 School Year)*

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

First NameLast Name
Child's Age*
Child's Gender*
Child's Shirt Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Child 2's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
For which Programs are you registering Child 2?*

Summer Camp, K-12th grade, Mon - Fri, 8am-6pm ($25 Registration + weekly fee)Summer Boxing, 12-17 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)Summer Martial Arts, 5-16 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)
Child 2 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level (2025-2026 School Year)*

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

First NameLast Name
Child's Age*
Child's Gender*
Child's Shirt Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Child 3's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
For which Programs are you registering Child 3?*

Summer Camp, K-12th grade, Mon - Fri, 8am-6pm ($25 Registration + weekly fee)Summer Boxing, 12-17 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)Summer Martial Arts, 5-16 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)
Child 3 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level (2025-2026 School Year)*

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

First NameLast Name
Child's Age*
Child's Gender*
Child's Shirt Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Child 4's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
For which Programs are you registering Child 4?*

Summer Camp, K-12th grade, Mon - Fri, 8am-6pm ($25 Registration + weekly fee)Summer Boxing, 12-17 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)Summer Martial Arts, 5-16 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)
Child 4 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level (2025-2026 School Year)*

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

First NameLast Name
Child's Age*
Child's Gender*
Child's Shirt Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Child 5's School*

AL Burruss ElementaryPark Street ElementarySawyer Road ElementaryWestside ElementaryMCAAMSGAMarietta Middle SchoolMarietta High SchoolOther
For which Programs are you registering Child 5?*

Summer Camp, K-12th grade, Mon - Fri, 8am-6pm ($25 Registration + weekly fee)Summer Boxing, 12-17 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)Summer Martial Arts, 5-16 yrs old, Tue & Thu, 6-8pm ($50 for 6 weeks)
Child 5 Ethnicity*

AsianCaucasianAfrican AmericanHispanicMixed RaceOther
Current Grade Level (2025-2026 School Year)*

K1st2nd3rd4th5th6th7th8th9th10th11th12th
To ensure your child's safety, please list if your child has a mental health diagnosis, allergies of any kind, or other medical condition PAL should be aware of?*
Marietta PAL requires 85% attendance. Will your child(ren) attend Summer Camp the full 6 weeks, but no less than 5 weeks?*

YesNo
Summer Camp hours are Monday thru Friday, 8am to 6pm. Will you need Early Drop-off (for an additional $20 per child per week to drop off between 7:30-7:59am)?*

YesNo
Do you wish to apply an Income-Based Weekly Scholarship Discount?*

Yes (If yes, you must the complete scholarship request form & provide income documentation within 2 days of this application. Instructions to be provided at the completion of this registration.No
Emergency Contact and Person Authorized to pick-up your child(ren) #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(ren) #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.
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 choose Weekly or Full Pay Option for Summer Camp or Summer Sports.*

Please check here to confirm you agree to allow Marietta PAL to process auto withdrawals for WEEKLY payments, to include 3% service fee.I will pay in full for the 6 weeks of Summer Camp.I am registering for Summer Sports Only (Martial Arts and/or Boxing)
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 Summer Program Registration Fees are non-refundable.*

PAL Summer Camp Registration Free

$25.00 Quantity

Summer Martial Arts (Tue & Thurs, 6-8pm)

$50.00 Quantity

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

$50.00 Quantity

Full Pay - 1 Child6 weeks of Summer Camp, if paid before 5/15/26

$620.00 Quantity

Full Pay - 2 Children6 weeks of Summer Camp, if paid before 5/15/26

$1,075.00 Quantity

Full Pay - 3 Children6 weeks of Summer Camp, if paid before 5/15/26

$1,475.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Marietta PAL 2026 Summer Camp Registration Form