DENVILLE P.A.L. GIRLS’ SOFTBALL

2009 Recreation League Registration

General Information: This registration form is used to register players for the Denville PAL Girls Softball Recreation League. It is for players attending Kindergarten through 12^th grade.

Key Dates: Registration forms and fees are due by January 10. A late fee will be assessed for registrations received between January 11 and January 31. We will be unable to guarantee a spot on a team for players whose registration forms are not received prior to January 31. These players will be added to a waiting list and may be added to teams if spots become available. Refunds will not be provided after March 28.

Additional Forms: Additional forms can be printed from our web site by clicking the “Forms” link from the Denville PAL Girls’ Softball Home page. The web site address is www.denvillesoftball.org.

Mail-In Registration Address: Mail completed registration forms and registration fees to the following address:

Denville PAL Girls Softball

11 Union Hill Road

Denville, NJ 07834

Registration Fees: Registration fees must accompany the registration form. Registration will not be complete until both the registration form and fee have been received. Make checks payable to Denville PAL Girls Softball. The following fees apply:

On-Time Registration (if received by January 10)

· Kindergarten - $30 per child up to 2, $5 for each additional child

· 1^st through 12^th Grades - $60 per child up to 2; $15 for each additional child

Late Registration (if received after January 10)

· Kindergarten - $35 per child up to 2; $5 for each additional child

· 1^st through 12^th Grades - $65 per child up to 2; $15 for each additional child

Registration may be verified by clicking on the “Registration Verification” link on the home page of the Denville Softball website (www.denvillesoftball.org).

PLEASE COMPLETE THE FOLLOWING SIDE

No participation permitted without complete medical information.

P.A.L Girls’ Softball Registration 2009 Season

Please Print Clearly (No participation permitted without complete medical information)

Player’s Current School Grade (K-12): _______________

Player Information:

Name: ___________________________________________ Date of Birth: ______________ Age: ______

Address: ________________________________________________________________________________

Town: ________________________________________ Zip Code: _________________

School: _________________________________________________________________ Grade: _________

Doctor’s Name: ______________________________________________ Phone: _____________________

Medical Insurance Company Name: ___________________________________________________________

Policy Number: __________________________________________ _____ No medical insurance

Please describe any medical or health problems your child may have: ________________________________

________________________________________________________________________________________

Does your child take any medication? _______ If yes, please list medication & dosage taken each day:

________________________________________________________________________________________

Is there medication to be taken in certain emergencies? _________ If yes, please describe:

________________________________________________________________________________________

Parent/Guardian Information:

Name 1: _______________________________________ Name 2: _______________________________________

Phone: (Home 1): _____________________ (Work 1): ____________________ (Cell 1): ___________________

Phone: (Home 2): _____________________ (Work 2): ____________________ (Cell 2): ___________________

Email Address 1: ________________________________ Email Address 2: _______________________________

Please indicate if you or family member(s) can help P.A.L. Girls Softball this season:

_____ Head Coach	_____ Assistant Coach
_____ Team Parent	_____ Board Member
_____ Business Sponsor

Name of individual willing to help: ______________________________ Contact Number: _____________________

Media Approval: Opportunities may be presented in which players names or pictures can appear in local news papers, our website, our newsletters, or other communications affiliated with Denville PAL Girls Softball. Please check the appropriate box below:

¨ You have my permission to use my daughter’s name and picture in publications

¨ Please do not use my daughters name or picture in publications

Registration Verification: Registration can be verified by clicking the “Registration Verification” link on the home page of the Denville Softball website (www.denvillesoftball.org). Verification will be posted within 5 days of registration receipt.

I, the parent or guardian of the above mentioned player, do hereby give permission in my absence for any necessary emergency medical treatment to be administered by a licensed physician or certified medical professional. I also give my approval for her participation in travel softball activities and assume all such risks and hazards incidental to participation and absolve, indemnity and agree to hold harmless Denville P.A.L Girls’ Softball, its sponsors, directors, managers, coaches, and other participants.

Parent/Guardian Signature: _______________________________________ Date: ______________

For Official Use Only: Amount __________ Check # __________