DANBURY PAL REGISTRATION FORM - Boys AAU BASKETBALL

Alternative text

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


YOU WILL BE RE-DIRECTED TO A PAYMENT PAGE WHEN YOU SUBMIT THIS FORM


THIS FIELD IS REQUIRED
REQUIRED
THIS FIELD IS REQUIRED
REQUIRED

PARENTAL INFORMATION


MEDICAL RELEASE INFORMATION

To induce the Danbury Police Activities League and its representatives to accept registration and permit participation by the above named minor child, I hereby give my permission and consent, and hereby agree to release, indemnify, and hold harmless the Danbury Police Activities League Inc. and its officers, coaches, and representatives from any claims rising from any injury to the above named minor participant.
Consent for medical treatment as the parent or legal guardian of the above mentioned player, I hereby give my consent for emergency care prescribed by a dully licensed Doctor of Medicine of Doctor of Dentistry. This care may be give under whatever conditions are necessary to preserve the life, limb, or well being of my dependant.

This is a legally binding electronic signature and REQUIRED
REQUIRED