Spring Volleyball Clinic

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

7th and 8th Grade Only
$75.00 for 6 Week Clinic


PARENT/GUARDIAN CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION


Consent to Treat:
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 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