DANBURY PAL STORM TRAVEL SOFTBALL

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

THIS FORM IS TO REGISTER FOR STORM TRAVEL SOFTBALL

ALL FIELDS ARE REQUIRED UNLESS OTHERWISE NOTED

AT THIS TIME WE WILL ONLY NEED A $250 DEPOSIT
TO HOLD YOUR SPOT

10U total of $425.00
Pay in Full- $425.00
Down payment- $200.00
Payment $125.00
Payment- $100.00

12U total of $700.00
Pay in Full- $700.00
Down payment- $250.00
payment $250.00
Payment- $200.00

14U division Total: $750.00
Down payment $375.00 due now
2nd payment $225.00
3rd payment $150.00


PARENT/GUARDIAN CONTACT INFORMATION


EMERGENCY CONTACT INFORMATION


MEDICAL INFORMATION (FILL OUT ONLY IF APPLICABLE)

(example: Asthma, bee stings, peanut butter, etc.)
(Epi-pen, inhaler, insulin etc.)

WAIVER:
To induce the Danbury Police Athletic League 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 PAL, its’ officers, staff, and representatives from any claims arising from any injury 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 dependent. I agree to pay all registration fees on timely basis. Any returned checks will result in a $25 fee to be paid by minors guardian.

This also gives PAL permission to take photography and/or video of said participant for the purpose of promoting programs on fliers, marketing material, and social media for PAL related purposes.

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

Danbury PAL Covid-19
WAIVER AND RELEASE OF LIABILITY
READ BEFORE SIGNING
In consideration of being allowed to participate in any way in PAL Storm Softball athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Danbury Police Activities League, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of the activity and his/her responsibilities for adhering to the rules and regulations. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all

liabilities incident to my minor child’s/ward’s involvement or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.


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

rev 09-03-20