Palisades Park Recreation

2024 Registration Form

Player Information

Program Selection (See The Completion Instructions Section Below For Payment Info)

(Choose 1)

Primary Contact Information

Emergency Contact Information

Waiver Information

1. EMERGENCY AUTHORIZATION: I, the undersigned parent or legal guardian of the above-named player, a minor ("Player”) hereby authorize each of the coaches, team parents, and/or other officials to act as my agents in the capacity of activity supervisors and vehicle drivers, and l authorize each of them as well as the above identified Emergency Contact to consent to medical, surgical or dental examination and/or treatment.

AUTORIZACION DE EMERGENCIA: Yo, el padre o tutor legal del jugandor arriba mencionado, un menor ("Jugador") decide autorizar cada uno de los entrenadores, padres de equipo, y / u otros funcionarios para actuar como mis agentes en la capacidad de la actividad supervisores y conductores de vehiculos, y autorizo ??a cada uno de ellos, asi como el identificado anteriormente Contacto de Emergencia de consentimiento para el examen y / o tratamiento medico, quirugico o dental.

2. I HAVE READ THE ABOVE EMERGENCY AUTHORIZATION, AND THE DISCLAIMER, ASSUMPTION OF RISK AND WAIVER, AND THE ACKNOWLEDGEMENT AND CONSENT AGREEMENTS PRINTED ON THE REVERSE SIDE OF THIS FORM, FULLY UNDERSTAND THE TERMS OF EACH, UNDERSTAND THAT I AND PLAYER HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING TO THESE TERMS, AND I SIGN THIS FORM MYSELF AND ON BEHALF OF PLAYER AND AGREE TO THESE TERMS FREELY AND VOLUNATIRY AND WITHOUT INDUCEMENT.

2. HE LEÍDO LA AUTORIZACIÓN DE EMERGENCIA ANTERIOR, Y EL DESCARGO DE RESPONSABILIDAD, LA ASUNCIÓN DE RIESGO Y RENUNCIA, Y LOS ACUERDOS DE RECONOCIMIENTO Y CONSENTIMIENTO IMPRESOS EN EL REVERSO DE ESTE FORMULARIO, ENTIENDO COMPLETAMENTE LOS TÉRMINOS DE CADA UNO, ENTIENDO QUE YO Y EL JUGADOR HEMOS RENUNCIADO A DERECHOS SUSTANCIALES AL FIRMAR ESTE FORMULARIO Y ACEPTAR ESTOS TÉRMINOS, Y FIRMO ESTE FORMULARIO YO MISMO Y EN NOMBRE DEL JUGADOR Y ACEPTO ESTOS TÉRMINOS LIBREMENTE Y VOLUNA Y SIN INDUCCIÓN.

Completion Instructions / Instrucciones de finalización

1. Make sure all required fields have been filled in.
(Asegúrese de que se hayan rellenado todos los campos obligatorios.)

2. Click on the "Send" button. When you receive the confirmation email, print 2 copies & mail with payment to the address below, or you can bring them to in-person registration if one is scheduled. Only then will the registration be complete.
(Imprimir 2 Copias Del Formulario De Inscripcion.)

3. This form allows one child to register and provide contact and Parent/Guardian information. Submitting this form does not hold a place for your child. Follow the instructions above to ensure registration is complete.

Please allow the server some time to send the email confirmation as it is not always instantaneous
Also, check your Spam/Junk Folder for the confirmation email
Forms will not be accepted at School or Borough Hall
Hand-written forms will not be accepted

DO NOT MAIL CASH
For Adult Basketball & Adult Volleyball, please enclose a check/money order made payable to "Palisades Park Recreation" for $60.00 per player, or
and mail with printed forms to:
Palisades Park Recreation
PO Box 385
Palisades Park, NJ 07650

Photo Consent Form

I grant permission to Palisades Park Recreation for the use of the photograph(s) or electronic media images as identified below in any presentation of any and all kind whatsoever, l understand that I may revoke this authorization at any time by notifying Palisades Park Recreation in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.

Digital Signature