Online Form.htm

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PAL Board of Directors

Colorado Springs Police Athletic League

Online Registration Form


Please fill out the form below for each PAL participant for EACH SPORT. 

Please provide the following contact information:

Registrations are only being accepted for the following sports. Please indicate which sport your child is registering for.

All fields in red must be completed before the form can be successfully submitted.

Sport Registration

     Tackle Football                        Flag Football                        Cheerleading Football

First Name
Last Name
Date of Birth
Current Age
Estimated Weight Football Only

*Note* Requires official weight measure by Parks and Recreation Staff.  Please be prepared to have your child officially weighed before the season.  A special date and time will be set up for PAL registrants.  Successful football registration cannot be successful without it.  Call 444-7618 with questions.

Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Today's Date
E-mail
School
Grade
Gender
Male   Female
   
Ethnicity

African American

Asian

Caucasian

Hispanic

Pacific Islander

Other

Family Income

Please know that PAL keeps 

this information confidential

and uses this information for

seeking grant and donor

dollars.

$0-$14,999

$15,000-$24,999

$25,000-$34,999

$35,000-$49,999

$50,000+

Decline- Not Recorded

Number in Household
T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

   
Do you want to volunteer to coach?

Yes, I want to be the head coach.

Yes, I want to be an assistant coach.

No, I do not want to coach.

   
Parent/Guardian  1
Parent/Guardian 1 Phone
Parent/Guardian 1 Work #
Parent/Guardian 1 Cell #
Parent/Guardian 1 Pager #
   
Parent/Guardian 2
Parent/Guardian 2 Phone
Parent/Guardian 2 Work #
Parent/Guardian 2 Cell #
Parent/Guardian 2 Pager #
   
Emergency Contact 1
Relationship
Home Phone
Work Phone
Cell Phone
Pager Phone
   
Emergency Contact 2
Relationship
Home Phone
Work Phone
Cell Phone
Pager Phone
 

PAL does NOT provide primary medical

insurance  on this youth – you MUST

have medical insurance. PAL insurance only

covers as a secondary policy.

Insurance Company Name
Insurance Company
Group #
Name Insured
Allergies/Medical Issues
   
Payment Method-

You will be taken to an online payment page upon successful submission of this form.

Online Payment (Check or Credit Card)

Check by mail

Check in person

Cash in person

Comments?

PAL PLEDGE

As a PAL participant, I promise to conduct myself in a respectful manner with all my coaches and other PAL participants.  Further, I pledge to keep all PAL activities drug, alcohol, and smoke free.

As a parent/guardian of the above participant, I affirm that my PAL player has read and agrees to the PAL Pledge.  

  Yes, I affirm.   Parent/Guardian Name

Emergency Notification & Release of Liability

If my child is injured while participating in a PAL activity, every effort will be made to contact me at the phone numbers I have listed above.  If I am unable to be reached, I’ve listed two other people (emergency contacts) who can be contacted. 

I agree to allow PAL to administer any necessary first aid treatment seen appropriate for my child.  As the parent or legal guardian of this child, I hereby authorize and give my consent for any emergency medical, surgical, or dental treatment deemed advisable by a qualified medical doctor or dentist, in the event of a medical or dental emergency that arises while participating at a PAL activity.

As the parent or legal guardian of the participant here listed, I hereby acknowledge and agree to hold harmless and release from civil liability, the Colorado Springs Police Athletic League, the National Police Athletic League, the Colorado Springs Police Department, and the City of Colorado Springs from any medical injury or personal or property damages that may arise while participating in a PAL activity. Through signing below, I agree to all of the above.

  Yes, I affirm.   Parent/Guardian Name

Photo Release

As a parent or legal guardian of the above participant, I give my permission for my child to be photographed or videotaped and allow PAL to release said pictures for publicity purposes.

  Yes, I affirm.  Parent/Guardian Name

By submitting this form, I understand that my child's registration will not be complete until payment is received.  (You will be taken to an online payment instruction page upon successful submission.)


                                 PAL Mission

The Mission of the Colorado Springs Police Athletic League is to enhance the partnership between the C.S.P.D. and community members by providing affordable, after-school and summer activities that nurture positive development, foster community responsibility and reduce participation in juvenile crime for youth who can most benefit.

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Copyright © 2003-2008 Colorado Springs Police Athletic League
Last modified: 06/09/08