Albany PAL Registration Form
This form may be used to apply for the following program opportunities; please check all that apply:
Albany PAL Running Club
Albany PAL Mentoring Club
Girl Scouts or Boy Scouts
Complete this form and bring it to your first event!
Please see the reverse side for program descriptions
Transportation to and from PAL events is your responsibility
For more information call Sgt. Leonard Ricchiuti @ the PAL Center at 435-0392
Name: ______Date of Birth: ______
Address:______Telephone:______
School: ______Grade: ______
Parent/Guardian: ______Relationship:______
E-Mail: ______Phone: (H/C) ______(W) ______
I/WE, the Parents or guardians of the above named candidate for a position on the Albany Police Athletic League Inc. (PAL), hereby give my/our approval for our child to participate in any and all PAL activities. I/we know that participation in PAL activities may result in serious injury, and that protective equipment does not prevent all injuries to players and/or participants, and I/we do hereby waive, release, absolve, indemnify and agree to hold harmless the Albany Police Athletic League, PAL Board members, National PAL, organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or any other cause. I/we do hereby give permission for my child to receive medical treatment in case of an emergency if I/we cannot be contacted. I/We do hereby give permission for my/our child’s photo likeness to be used in any and all PAL promotional literature.
Parent / Guardian Signature: ______
Hospitalization Plan: ______Policy #______Allergies: ______
Doctor______Doctors Telephone: ______
Person to be contacted in case of injury, if parent or guardian is unable to be contacted
Name______Phone#______
THIS IS NOT A SCHOOL DISTRICT SPONSORED EVENT. THE CITY SCHOOL DISTRICT OF ALBANY IS NOT RESPONSIBLE OR LIABLE FOR ANY PROBLEMS OR DAMAGES ARISING FROM PARTICIPATION IN THIS ACTIVITY.
See Important Information on the reverse side!
Fall Running Club
Tuesday & Thursday Nights
At the Washington Park Lake House – 5:30-7:00pm
September 22 –November 12th, 2015
***Open to all youth ages 6 - 14***
The Albany Police Athletic League (PAL), Inc. will be holding the 2015 Fall Running Club at Albany’s Washington Park meeting at the Lake House. Youth from around the city will participate in skills and drills that will increase their talents in long-distance races. Students will also receive nutrition and fitness lessons. The club will end with an area 3K youth run.
This is a free program.
Mentoring Program
Wednesday 5:30 – 7:00 pm & Thursday Nights / 6:00 – 7:30 pm
& Saturdays 11:00am - 12:30pm
The Albany PAL Center @VI, 844 Madison Ave. (Corner of Ontario)
October 14th, 2015 –May 19, 2016
***Open to all youth ages 5 - 15***
The Mentoring Program meets weekly at the Albany PAL Center and engages students in educational, sports, arts, and social-skill building opportunities that will enhance their life skills for success in school, and beyond! Students interact one-on-one or two-on-one in a group environment with our mentors under the supervision of the Mentoring Coordinator.
This is a free program.
Girl Scouts & Boy Scouts
***Girl Scouts Wednesday 6-7pm & Boy Scouts Thursday 6-7pm***
The Albany PAL Center @VI, 844 Madison Ave. (Corner of Ontario)
October 14th, 2015 –May 19, 2016
***Open to all youth ages 7 - 11***
Albany PAL invites you to learn life skills through your local Girl & Boy Scouts Chapter here at the Albany PAL Center. Youth will meet weekly with their Troop Leader and participate in varies challenges to earn their badges.
This is a free program.