DANBURY PAL BASKETBALL REGISTRATION FORM

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

THIS FORM IS TO REGISTER FOR THE TRAVEL BASKETBALL PROGRAM

TRAVEL BASKETBALL $235.00
UNIFORM $65.00
(shorts $30.00, shirts $35.00 - can be purchased seperatley)

ALL FIELDS ARE REQUIRED UNLESS OTHERWISE NOTED


PARENT/GUARDIAN CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION


MEDICAL INFORMATION



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

TRAVEL BASKETBALL

PLEASE CHOOSE A SHORTS AND SHIRT SIZE
FROM THE CHOICES BELOW

REQUIRED
REQUIRED

AFTER SUBMITTING THIS FORM, YOU WILL BE RE-DIRECTED TO A PAYMENT PAGE THAT WILL GIVE YOU THE OPTION OF PAYING ONLINE OR PRINTING OUT A FORM TO MAIL IN