DANBURY PAL BASKETBALL REGISTRATION FORM

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35 Hayestown Road
Danbury, CT 06811
203-778-4725
Fax: 203-730-2660

P.A.L. 3v3 BASKETBALL TOURNAMENT
$35.00 per player

EACH TEAM MEMBER MUST FILL OUT A SEPERATE REGISTRATION. PLEASE REMEMBER YOUR TEAM'S NAME

ALL FIELDS ARE REQUIRED UNLESS OTHERWISE NOTED

NOT REQUIRED IF THERE ARE NO MEDICAL CONDITIONS

PARENT/GUARDIAN CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION



REQUIRED FIELD

FIRST AND LAST NAME OF PLAYERS ON TEAM: (OTHER THAN YOURSELF, 3-5 PLAYERS PER/TEAM)
LEAVE BLANK IF YOU DON'T KNOW THE OTHER PLAYERS

To induce the Danbury Police Activities League Inc. to accept registration and permit participation by the above mentioned minor child, I hereby give my permission and consent, agree to release, indemnify, and hold harmless the Danbury P.A.L, its officers, staff, and representatives from any claims arising from any injury to above named minor. I hereby give my consent for emergency care prescribed by duty licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent.

This also gives PAL permission to take photography and/or video of said participant for the purpose of promoting programs on fliers, social media, and other ways PAL sees fit.

By entering your name below constitutes an electronic signature
that is legal as if you actually signed this document with a pen.

AFTER SUBMITTING THIS FORM, YOU WILL BE
RE-DIRECTED TO A PAYMENT PAGE