Registration Form

P.A.L Girls’ Softball Registration 2010 Season

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

Mail-In Registration Address: Denville PAL Girls Softball - 11 Union Hill Road - Denville, NJ 07834

Registration Fees: Mail fees with registration form. Make checks payable to Denville PAL Girls Softball.

Player’s School Grade	On-Time Registration (prior to Jan 10)	Late Registration (after Jan 10)
Kindergarten	$30 per child up to 2; $5 for each additional	$35 per child up to 2; $5 for each additional
1^st through 12^th Grades	$60 per child up to 2; $15 for each additional	$65 per child up to 2; $15 for each additional

Note: Player participation can not be guaranteed for registration forms received after January 31, 2010.

Player Information:

Name: _____________________________________________________ Date of Birth: ______/_______/____________

Address: ___________________________________________________________________________________________

Town: ________________________________________ Zip Code: _________________

School: _________________________________________________________________ Grade: ____________________

Doctor’s Name: ______________________________________________ Phone: ________________________________

Medical Insurance Company Name: ___________________________________________________________

Policy Number: __________________________________________ _____ No medical insurance

Existing health issues: __________________________________________________________________________________

Daily Medication & Dosage: _____________________________________________________________________________

Emergency Medication and Situation: ______________________________________________________________________

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.

Additional Forms - Registration forms may also be accessed from the Denville PAL Girls Softball website (www.denvillesoftball.org) or from the Denville Recreation Department.

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 # __________

PLEASE COMPLETE THE FOLLOWING SIDE

Denville Police Athletic League

Release and Waiver of Liability

and Indemnity Agreement

(Read Carefully Before Signing)

In consideration of being permitted to participate in any way in the league or organization indicated below and/or being permitted to enter for any purpose any restricted area (herein defined as any area wherein admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:

1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all precaution to avoid the unsafe area and REFUSE TO PARTICIPATE further.

2. I/We fully understand and acknowledge that:

a. There are risks and dangers associated with participation of athletic activities which could result in bodily injury, partial and/or total disability, paralysis and death.

b. The social and economic losses and/or damages, which could result from those risks and dangers described above, could be severe.

c. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.

d. There may be other risks not known to us or are not reasonably foreseeable at this time.

3. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.

4. I/We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.

5. EACH OF THE UNDERSIGNED further expressly agrees that the forgoing release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the Province or State in which the organization is conducting events and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

6. On behalf of the participant and individually, the undersigned parents(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parent(s) and or/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY, INCLUDING ANY NEGLIGENCE OF THE ORGANIZATION NAMED BELOW, TO THE GREATEST EXTENT ALLOWED BY LAW.

Name of Organization: Denville Police Athletic League

Parent or Guardian Signature (if minor): ______________________________________________

Printed Name of Participant: ________________________________________________________

Address of Participant: ____________________________________________________________

Received by: _________________________________________________________________________________________

Registrar Signature Printed Name Date

PLEASE COMPLETE THE FOLLOWING SIDE