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

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

You must choose Safety Town, Junior Police Academy or Basketball. Please complete one form per child. The $10 CASH enrollment fee is required prior to the start of the program for the applicaiton to be processed.

Child's Name*

First Last

Child's Sex*

T-shirt Size*

Child's Date of Birth*

Home Address*

Street Address Address Line 2 City State ZIP Code

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.

CLICK HERE TO PAY YOUR $10 REGISTRATION FEE

I affirm that I have clicked the link above and paid my $10 registration fee via zeffy. I understand that my child will not be registered without payment.*

YES

Phone

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

PAL Program Enrollment Form