Elementor #2824 – Millville Police Athletic League

Applicant's Name *

Address *

City *

State *

Zip Code *

Email *

Cell Phone *

Date of Birth

School Attended

Grade

Free or Reduced Lunch Program

This helps us when applying for grant funding to support and enhance the PAL Program.

Certification *

I, being the parent or legal guardian of the applicant, do hereby approve of his/her participation in all activities the Millville Police Athletic League and to hereby release the City of Millville, the Millville PAL Organization including it's Board & Officers, the Millville Police Department, the Millville Board of Education and it's members and any officials and/or coaches being employees of the organization, whether paid and/or volunteer, from all liability from persona injury and/or property damage resulting from his/her participation in any of the PAL activities in which he/she may take part. The PAL Organization reserves the right to cancel and/or suspend any membership of those individuals not complying with its rules and regulations.

Signature (Parent/Guardian) *

I have read the above and understand and agree to comply with all PAL policies.

Date *