Danbury P.A.L Summer Experience Registration Form

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

ALL FIELDS ARE REQUIRED UNLESS OTHERWISE NOTED

Child Information:

To recieve multiple child discount, children must be in the same family at the same address

FIRST CHILD REGISTRATION FEE AND SCHEDULE


SECOND CHILD REGISTRATION FEE AND SCHEDULE


THIRD CHILD REGISTRATION FEE AND SCHEDULE


PARENT/GUARDIAN CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION


To induce the Danbury Police Activities League Inc. to accept registration and permit participation by the above named 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 duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

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

I agree to pay all registration fees on timely basis. A fee of $25 will be charged for each returned check

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. ANY DISCOUNTS WILL BE TAKEN AT CHECKOUT