Registration

Registration
Status: *
Activity: *
Child's Name (First,Last): *
Child's Age: *
Gender *	Male Female
Date of Birth:
Address (1):
Address (2):
City:
State:
Zip: *
School Name
Grade (this September) *
Parent Name (first/last) *
Relation To Child *
Address 1 (If different)
Address 2 (if different)
City (if different)
State (if different)
Zip (if different)
Email Address *
Home Phone
Cell Phone
Payment Confirmation Number *
	I, the parent/guardian of the above listed child, hereby give my approval for my son/daughter to participate in the above indicated activity. I assume all risks and hazards incidental to such participation, including transportation to and from the activity and I do hereby waive, release, absolve, indemnify and agree to hold harmless the Egg Harbor Township Police Department, the Egg Harbor Township Police Athletic League, its organizers, employees and Board of Directors, sponsors, supervisors, participants and persons transporting my child to or from activities, and for any and all claims arising out of any injury to my child, whether the result of negligence or for any other cause. I also give permission for PAL to use pictures of my child in the promotion of the organization. It is further understood that my submitting of this registration form indicates that I have read this form, have explained it to my child and I understand and fully agree with the statements made.
Anti-Spam *

We wouldn't be successful without the support of our great sponsors!