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 -
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 |
|
1st
through 12th 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
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):
______________________________________________
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