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Summer Camp Total

Student's Information

Students Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Female

Male

School(Required)

Yes, they attend school.

Not yet.

Homeschooled, other

School

Student's Health Information

Does your child have allergies, chronic illness, or medical conditions that would limit any level of activity?

Acknowledgement of Risk & Waiver of Liability(Required)

By checking this box I acknowledge that i have had sufficient opportunity to review the provisions of this document and understand its purpose, meaning and intent.

In consideration of the right to participate in the New Britain PAL Programs, I do hereby, for myself, my heirs, and executors release the New Britain Police Athletic League, the City of New Britain, and all coaches, agents, employees or personnel of said parties from any and all liability for property damage, bodily harm, or any other damages suffered while participating in said Programs and accordingly waive any and all right to bring suit against the New Britain Police Athletic League, the City of New Britain, the coaches, agents, employees or personnel.

The undersigned further acknowledges that all Programs involve exercise and poses an inherent risk of bodily injury. The undersigned, therefore, certifies that the participant named above is in satisfactory physical condition.

Parent's Information

Parent Name(Required)

First Last

Address(Required)

Street Address City State Zip code

Phone(Required)

Email(Required)

Can this person be used as an emergency contact?*(Required)

Yes

No, someone else should be used

Emergency Contact Name

First Last

Emergency Contact Phone Number

Payment Information

Credit Card(Required)

Card Details

Cardholder Name

Total Due:

Session Full

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SUMMER CAMP SIGN UP

Register for Summer Camp: Open Now

Student's Information

Student's Health Information

Parent's Information

Payment Information

Session Full

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