Mail-in Registration
Form
PRINT THIS FORM
AND MAIL IT ALONG WITH YOUR PAYMENT TO:
Chelmsford
Police Athletic League, 2 Olde North Road, Chelmsford, MA 01824
Name of
Participant:
Age:
DOB:
Name of Parent(s)/Guardian(s):
Grade:
Address:
Emergency Phone:
#1
#2
Email
Address:
PAYMENT
METHOD:
Check
(included)
Cash
(included)
Paid
online via Paypal below
(NOT available for
Volleyball)
Payment Waiver
Request
Please note that we are
unable to accommodate any coaching
or team requests at this time.
Waiver
Form (By
checking this box and signing below you are agreeing to
the terms of the Waiver Form.)
I, the undersigned and parent/guardian of
__________________________ do hereby release and discharge
CPAL, the Chelmsford Police and its agents, employees,
officers, referees, and facilities from all claims,
demands, actions, and judgments which I have, or claim to
have, against the above for all personal injuries, and to
all injuries to property, both real and personal, incurred
by my child caused by, or arising out of, participation in
games, practices, or other functions sponsored by CPAL,
the Chelmsford Police, its agents, employees, and
officers.
My child has no physical condition that would prevent
him/her from participating in the games, practices, or
programs sponsored by CPAL and the Chelmsford Police. My
child is in good health and physical condition. I fully
understand the dangers involved in this type of exercise,
function, competition, and practice.
The Chelmsford Police recommend all participants have a
physical health examination prior to participation in the
League. Consult your doctor if you are unsure about your
child’s ability to participate in this type of activity.
While rules exist to control play, this is a contact sport
and contact should be expected.
It is the responsibility of the individual participant’s
parent/guardian to maintain his/her child’s health and
accident insurance. CPAL, the Chelmsford Police and its
agents, employees, and officers accept no responsibility
in this matter. I, as a parent/guardian of
_______________________ accept all risk regarding my
child’s participation in this League. I also authorize any
member of the Chelmsford Police Department to provide any
treatment for injury or medical emergency in case of my
absence.
Signature of Parent/Guardian
Printed Name of Parent/Guardian
Date
All
registration forms must be accompanied by payment or
written Payment Waiver request. All PayPal payments must
submit the Registration Form separately within 2 days of
the PayPal transaction to ensure a spot on the Team
Rosters.
Pay Online with PayPal
Football/Hockey: $25 (Maximum $50 per family)
Golf: $125 per golfer 2012 Spring Volleyball is
FULL!
