Form Mock Up | Euclid Police – 545 E 222nd St

Select the Program: Safey Town, Junior Police Academy or Sports*

Safety Town
Junior Police Academy
Sports

You must choose Safety Town, Junior Police Academy or Sports. Please complete one form per child.

Child's Name*

First Last

Child's Sex*

Female
Male

T-shirt Size*

T-shirts are for Safety Town and Junior Police Academy only.

Child's Date of Birth*

Child's School*

Grade Level in School*

Home Address*

Street Address Address Line 2 City State ZIP Code

Parent or Guardian Name*

Parent or Guardian's Email Address*

Parent or Guardian's Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

Activity Disclaimer / Photo Waiver*

In consideration of my child’s participation in Euclid Police Activities League (PAL) and Junior Police Academy, I hereby waive and relinquish any and all claims, demands, and/or causes of action whatsoever. This includes any legal fees and/or related costs against the City of Euclid, its employees, or a Euclid PAL agent and or volunteer(s) while at any PAL activity or while in transport. I hereby give my permission to the Euclid Police Activities League to use the above Name(s) and any photos of my child for the use in print, radio, and media ads for the purpose of marketing, publicity, and/or recruiting (members, volunteers, and supporters) for Euclid PAL. This application also authorizes the Euclid Police Department/Euclid PAL to secure emergency transportation for your child if needed. This does not authorize or guarantee treatment upon arrival at the designated source of emergency service, as each facility has its own treatment policies and procedures.

Signature*

Your printed parent or guardian name is your signature for this form and is your consent to enroll your child in PAL programs.

I understand I must pay a $10 yearly fee for my child to participate.*

YES

Payment*

Online by Zeffy link below
Paying cash upon arrrival

CLICK HERE TO PAY YOUR $10 REGISTRATION FEE BY ZEFFY

Name

This field is for validation purposes and should be left unchanged.

PAL Program Enrollment Form