Howell PAL. P.O. Box 713, 115 Kent Road Phone: Fax

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Howell PAL P.O. Box 713, 115 Kent Road Phone: 732-919-2825 Fax 732-919-1212 www.howellpal.

will vary in the morning Three coed age groups with basic instruction 1 st 2 nd grade, 3 rd 5 th grade, 6 th 8 th grade Participants must be Attending 1 st 8 th grade during the 2016/2017 school year

1 Howell PAL P.O. Box 713, 115 Kent Road Phone: Fax Howell PAL Flag Football Registration Form When: Saturday s starting September 24th, 2016 Length of Program: 09/24 through 10/29 (6 weeks) Where: Games Played at Southard School Time: game time will vary in the morning Three coed age groups with basic instruction 1 st 2 nd grade, 3 rd 5 th grade, 6 th 8 th grade Participants must be Attending 1 st 8 th grade during the 2016/2017 school year Open Registration: NOW September 2nd Fee: $65.00 Late Registration: September 3rd September 10th Fee: $75.00 Please sign up for REMIND 101 to receive notifications for the program by texting the number with the text All Registrations Must Be Postmarked By September 10 th Please Make Check Payable To Howell PAL (Parent) Would You Be Willing To Assist or Coach? Fingerprinted? Name of volunteer coach: Coaches Shirt Size Participant s Name: Age: Address: Birthdate: Address (mandatory): (2016/2017) Grade: Zip Code: Primary # Secondary # (Child) Has Asthma: Uses Inhaler: Heart Condition: Jersey Size YM YL YXL AM AL AXL Emergency Contact Name: Relation: Primary #: (Signature of Parent/ Legal Guardian) (Date) (PAL Office Use Only) CHECK CASH AMT RECEIVED BY

2 HOWELL POLICE ATHLETIC LEAGUE PARTICIPANT WAIVER NOTE: This form must be read and signed before the member is allowed to take part in a PAL program. By signing this form, the participant and/or parent or guardian agrees that they have read this waiver, understand the terms set forth herein and knowingly and voluntarily agree to the terms of this waiver. Program Name: Member s Name: Address: Phone #: DOB: In consideration of my involvement in the program under the auspices of the Howell PAL (and/or its officers, volunteers, staff, sponsors, agents, members and/or activity participants) I hereby agree that: I acknowledge that by participating in the sport by its very nature: 1. I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMBERMENT OR DEATH. While the particular rules of the sport, equipment, personal training and discipline may reduce this risk. The risk of injury does exist, as does the risk of damage to or loss of property. 2. I knowingly and freely assume all risks both known and unknown, even if arising from negligence of the above mentioned parties. 3. I willingly agree to comply with the stated and customary terms and conditions for participants, if however I observe any unusual or unnecessary hazard during my presence or participation, I will bring these incidents to the immediate attention of the nearest Howell PAL Staff/Chaperone. 4. For myself, and on behalf of my heirs, those assigned as a personal representative and my next of kin, I hereby: Release, Indemnify and hold harmless and agree not to sue, file a claim for relief or otherwise take legal action against the Howell PAL, their officers, volunteers, staff, or sponsors. Further I and/or my parent/guardian Releases from liability of any of the aforementioned from any liability from any and all injury and loss arising from my participation, whether caused by negligence or otherwise, except that which is the result of gross negligence or wanton misconduct. This indemnification shall include the payment of the Howell PAL s reasonable attorney s fees in defense of any claim filed by you. 5. I grant the Howell PAL, its representatives and employees the right to take photographs of my child in connection with the above identified subject. I authorize Howell PAL, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Howell PAL may use such photographs of my child with or without their name for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I have read this Howell Police Athletic League Participation Waiver and fully understand its terms. By signing this Waiver I acknowledge that I have done so both freely and voluntarily. This signature is to certify that I, as a adult participant or the parent/guardian with legal responsibility for this participant who is a minor, consent to the above mentioned and agree to his/her release, and also agree for myself/ourselves, my/our heirs, assigns and next of kin, to release and indemnify the Howell PAL from all liability, incidents to my /our child s involvement as stated above. X Parent/Guardian Signature Date Signed X Member Signature Date Signed

4 Description of the program: This is a program available to children with special needs. Each week a fun activity is planned with the assistance of PAL employees. The children are given the opportunity to learn appropriate socialization skills, interact with other children their age, and go on various community trips. THIS PROGRAM IS FREE OF CHARGE When: Mondays starting September 19th June 2017 (Every Monday that schools are open during the academic year) Where: Memorial Elementary School Time: 4:00-6:00pm Participant Name: Address: Zip Code: Phone #: Cell #: Date of Birth: address: Program Registering For: EMERGENCY CONTACT: Name: Relation: Phone #: Cell #: Please answer the additional questions on the next few pages so we are best able to care for your son or daughter Child s Personality Traits: 1. Favorite Activities 2. Major Dislikes 3. Favorite Family Activity 4. Best Friend 5. Favorite TV Programs 6. Favorite Movie/Story

5 7. Favorite Music/Song 8. Favorite Board Games 9. Enjoys Arts & Crafts Drama Other 10. Possess a Unique Skill 11. Enjoys individual Activities Group Activities 12. Describe swimming abilities 13. List specific fears (dark, bugs, noise, etc.) 14. Describe typical angry response 15. Are there any therapeutic exercises that you would like continued Personal Physical Information 1. Does participant wear: glasses hearing aid other Specify 2. Able to dress without assistance Yes No (describe ability) 3. Able to use bathroom facility unassisted Yes No (describe ability) 4. Please list major birth marks/ scars/ previously broken bones 5. List all known medical allergies (ex. Un, specific foods, specific juices, insect bites. etc) 6. Describe Reaction 7. Describe any other permanent information that will assist our staff Medical Information: 1. Define participants mental prognosis and/or school classification (Ex. Down s syndrome, brain damage, ADHD, Aspergers, etc.) 2. Does participant take medication on a regular basis Yes No If so what and when?

6 *Please be aware the Howell PAL staff is prohibited from administering any type of medication. Parents must administer all medications* 3. Medical Allergies 4. Any physical restrictions for activity 5. Check Appropriately Seizure History- No Yes Heart condition No Yes Mumps Measles Chick Pox Whooping Cough Hernia Pneumonia German Measles Typhoid Scarlet Fever Rheumatic Fever Diphtheria Paralysis Height Weight Eyes Ears Throat Nose Skin/Scalp Teeth Muscular Development Extremities Has participant been treated for? Asthma Hay fever Bronchitis Chronic Sinus I verify all medical conditions have been disclosed and accept full responsibility. I give permission to call 911 in case of emergency and provide this information X Parent/Guardian Signature Date

7 HOWELL POLICE ATHLETIC LEAGUE PARTICIPANT WAIVER NOTE: This form must be read and signed before the member is allowed to take part in a PAL program. By signing this form, the participant and/or parent or guardian agrees that they have read this waiver, understand the terms set forth herein and knowingly and voluntarily agree to the terms of this waiver. Program Name: Member s Name: Address: Phone #: DOB: In consideration of my involvement in the program under the auspices of the Howell PAL (and/or its officers, volunteers, staff, sponsors, agents, members and/or activity participants) I hereby agree that: I acknowledge that by participating in the event put on by the PAL by its very nature: 1. I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMBERMENT OR DEATH. While the particular rules of the sport, equipment, personal training and discipline may reduce this risk. The risk of injury does exist, as does the risk of damage to or loss of property. 2. I knowingly and freely assume all risks both known and unknown, even if arising from negligence of the above mentioned parties. 3. I willingly agree to comply with the stated and customary terms and conditions for participants, if however I observe any unusual or unnecessary hazard during my presence or participation, I will bring these incidents to the immediate attention of the nearest Howell PAL Staff/Chaperone. 4. For myself, and on behalf of my heirs, those assigned as a personal representative and my next of kin, I hereby: Release, Indemnify and hold harmless and agree not to sue, file a claim for relief or otherwise take legal action against the Howell PAL, their officers, volunteers, staff, or sponsors. Further I and/or my parent/guardian Releases from liability of any of the aforementioned from any liability from any and all injury and loss arising from my participation, whether caused by negligence or otherwise, except that which is the result of gross negligence or wanton misconduct. This indemnification shall include the payment of the Howell PAL s reasonable attorney s fees in defense of any claim filed by you. 5. I grant the Howell PAL, its representatives and employees the right to take photographs of my child in connection with the above identified subject. I authorize Howell PAL, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Howell PAL may use such photographs of my child with or without their name for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. YES NO I have read this Howell Police Athletic League Participation Waiver and fully understand its terms. By signing this Waiver I acknowledge that I have done so both freely and voluntarily. This signature is to certify that I, as a adult participant or the parent/guardian with legal responsibility for this participant who is a minor, consent to the above mentioned and agree to his/her release, and also agree for myself/ourselves, my/our heirs, assigns and next of kin, to release and indemnify the Howell PAL from all liability, incidents to my /our child s involvement as stated above. X Parent/Guardian Signature Date Signed

9 Description of the program: This is a program available to children with special needs. Each week a fun activity is planned with the assistance of PAL employees. The children are given the opportunity to learn appropriate socialization STAR Program SHARP Program skills, interact with other children their age, and go on various community trips. When: Thursday Evenings When: Tuesday Evenings (bring a snack or money for All Registrations and payment due September 20 th *Make checks payable to Howell PAL* snack bar.) Time: 6:15-8:15 p.m. Fee: $75 (trips are separate prices) Time: 6:15-8:15 p.m. Fee: $75 plus additional $3.00 a game (includes shoe rental) A phone call will be provided prior to the first class with a time the children will be picked up Bus will drop children off between 8:00 & 8:30 Bus will drop children off between 8:00 & 8:30 Place: Memorial Middle School For children grades 2 nd 8th STAR Program (Thursdays) Sept. 29 Nov. 3 Place: Ocean Bowling Lanes For High School Young Adult SHARP Program (Tuesdays) Sept. 27 th Nov. 15th Participant Name: Address: Zip Code: Phone #: Cell #: Date of Birth: address: Program Registering For: EMERGENCY CONTACT: Name: Relation: Phone #: Cell #: Please answer the additional questions on the next few pages so we are best able to care for your son or daughter Child s Personality Traits: 1. Favorite Activities

10 2. Major Dislikes 3. Favorite Family Activity 4. Best Friend 5. Favorite TV Programs 6. Favorite Movie/Story 7. Favorite Music/Song 8. Favorite Board Games 9. Enjoys Arts & Crafts Drama Other 10. Possess a Unique Skill 11. Enjoys individual Activities Group Activities 12. Describe swimming abilities 13. List specific fears (dark, bugs, noise, etc.) 14. Describe typical angry response 15. Are there any therapeutic exercises that you would like continued Personal Physical Information 1. Does participant wear: glasses hearing aid other Specify 2. Able to dress without assistance Yes No (describe ability) 3. Able to use bathroom facility unassisted Yes No (describe ability) 4. Please list major birth marks/ scars/ previously broken bones 5. List all known medical allergies (ex. Un, specific foods, specific juices, insect bites. etc) 6. Describe Reaction

11 7. Describe any other permanent information that will assist our staff Medical Information: 1. Define participants mental prognosis and/or school classification (Ex. Down s syndrome, brain damage, ADHD, Aspergers, etc.) 2. Does participant take medication on a regular basis Yes No If so what and when? *Please be aware the Howell PAL staff is prohibited from administering any type of medication. Parents must administer all medications* 3. Medical Allergies 4. Any physical restrictions for activity 5. Check Appropriately Seizure History- No Yes Heart condition No Yes Mumps Measles Chick Pox Whooping Cough Hernia Pneumonia German Measles Typhoid Scarlet Fever Rheumatic Fever Diphtheria Paralysis Height Weight Eyes Ears Throat Nose Skin/Scalp Teeth Muscular Development Extremities Has participant been treated for? Asthma Hay fever Bronchitis Chronic Sinus I verify all medical conditions have been disclosed and accept full responsibility. I give permission to call 911 in case of emergency and provide this information X Parent/Guardian Signature Date

12 HOWELL POLICE ATHLETIC LEAGUE PARTICIPANT WAIVER NOTE: This form must be read and signed before the member is allowed to take part in a PAL program. By signing this form, the participant and/or parent or guardian agrees that they have read this waiver, understand the terms set forth herein and knowingly and voluntarily agree to the terms of this waiver. Program Name: Member s Name: Address: Phone #: DOB: In consideration of my involvement in the program under the auspices of the Howell PAL (and/or its officers, volunteers, staff, sponsors, agents, members and/or activity participants) I hereby agree that: I acknowledge that by participating in the event put on by the PAL by its very nature: 1. I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMBERMENT OR DEATH. While the particular rules of the sport, equipment, personal training and discipline may reduce this risk. The risk of injury does exist, as does the risk of damage to or loss of property. 2. I knowingly and freely assume all risks both known and unknown, even if arising from negligence of the above mentioned parties. 3. I willingly agree to comply with the stated and customary terms and conditions for participants, if however I observe any unusual or unnecessary hazard during my presence or participation, I will bring these incidents to the immediate attention of the nearest Howell PAL Staff/Chaperone. 4. For myself, and on behalf of my heirs, those assigned as a personal representative and my next of kin, I hereby: Release, Indemnify and hold harmless and agree not to sue, file a claim for relief or otherwise take legal action against the Howell PAL, their officers, volunteers, staff, or sponsors. Further I and/or my parent/guardian Releases from liability of any of the aforementioned from any liability from any and all injury and loss arising from my participation, whether caused by negligence or otherwise, except that which is the result of gross negligence or wanton misconduct. This indemnification shall include the payment of the Howell PAL s reasonable attorney s fees in defense of any claim filed by you. 5. I grant the Howell PAL, its representatives and employees the right to take photographs of my child in connection with the above identified subject. I authorize Howell PAL, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Howell PAL may use such photographs of my child with or without their name for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I have read this Howell Police Athletic League Participation Waiver and fully understand its terms. By signing this Waiver I acknowledge that I have done so both freely and voluntarily. This signature is to certify that I, as a adult participant or the parent/guardian with legal responsibility for this participant who is a minor, consent to the above mentioned and agree to his/her release, and also agree for myself/ourselves, my/our heirs, assigns and next of kin, to release and indemnify the Howell PAL from all liability, incidents to my /our child s involvement as stated above. X Parent/Guardian Signature Date Signed (PAL Office Use Only) All CHECK refunds are governed CASH by the Howell AMT Township Refund RECEIVED Guidelines BY & Procedures

13 P.A.L. STAR PROGRAM Please hand money in to Ms. Jackie/Ms. Connie 9/29 Jackson Park Meet and Greet (bring snack) 10/6 Arts & Crafts Therapy at Southard School (bring $5.00) 10/13 Belmar Beach (bring $5.00 for Dunkin Donuts) 10/20 Sky Zone (bring $15) 10/27 Swing time (bring $7) 11/3 Freehold Mall/ Dollar General (bring money for dinner in the food court and Dollar General) *Please remember PAL programs are a peanut free zone due to children's allergies* The above lists all trips including any additional costs to attend. Please sign below and initial on the line above for all trips that your child will be attending. Name Date

What is Tai Chi? Tai Chi is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do Tai Chi, you perform a series of postures or movements in a slow, graceful manner.

Tai Chi is used to reduce stress, increase flexibility, improve muscle strength and definition, increase energy, stamina and agility and increase feelings of well-being.

15 What is Tai Chi? Tai Chi is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do Tai Chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pausing. Anyone, regardless of age or physical ability, can practice this form. Tai Chi is used to reduce stress, increase flexibility, improve muscle strength and definition, increase energy, stamina and agility and increase feelings of well-being. When: Tuesday and Thursday Evenings Make checks payable to Howell PAL Class Dates: Nov. 22 & 29 Dec. 1, 6, 8, 15, 27, 29 Jan. 3 & 5 (NO Class 12/13, 12/20, 12/22) Where: Echo Lake (located at 1225 Maxim Southard Road) Time: 7:00pm-8:00pm Fee: $50 for 10 classes (meets Tuesday and Thursday) Mail registrations to: 115 Kent Road PO Box 713 Howell, NJ Cut on Dotted Line Participant Name: Address: Zip Code: Phone #: Cell #: Date of Birth: address: Program Registering For: Tai Chi Current Medication: Medical Conditions: EMERGENCY CONTACT: Name: Relation: Phone #: Cell #: Applicant s Signature Please PRINT full name Date (PAL Office Use Only) CHECK CASH AMT RECEIVED BY

16 HOWELL POLICE ATHLETIC LEAGUE PARTICIPANT WAIVER NOTE: This form must be read and signed before the member is allowed to take part in a PAL program. By signing this form, the participant and/or parent or guardian agrees that they have read this waiver, understand the terms set forth herein and knowingly and voluntarily agree to the terms of this waiver. Program Name: Member s Name: Address: Phone #: DOB: In consideration of my involvement in the program under the auspices of the Howell PAL (and/or its officers, volunteers, staff, sponsors, agents, members and/or activity participants) I hereby agree that: I acknowledge that by participating in the event put on by the PAL by its very nature: 1. I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMBERMENT OR DEATH. While the particular rules of the sport, equipment, personal training and discipline may reduce this risk. The risk of injury does exist, as does the risk of damage to or loss of property. 2. I knowingly and freely assume all risks both known and unknown, even if arising from negligence of the above mentioned parties. 3. I willingly agree to comply with the stated and customary terms and conditions for participants, if however I observe any unusual or unnecessary hazard during my presence or participation, I will bring these incidents to the immediate attention of the nearest Howell PAL Staff/Chaperone. 4. For myself, and on behalf of my heirs, those assigned as a personal representative and my next of kin, I hereby: Release, Indemnify and hold harmless and agree not to sue, file a claim for relief or otherwise take legal action against the Howell PAL, their officers, volunteers, staff, or sponsors. Further I and/or my parent/guardian Releases from liability of any of the aforementioned from any liability from any and all injury and loss arising from my participation, whether caused by negligence or otherwise, except that which is the result of gross negligence or wanton misconduct. This indemnification shall include the payment of the Howell PAL s reasonable attorney s fees in defense of any claim filed by you. 5. I grant the Howell PAL, its representatives and employees the right to take photographs of my child in connection with the above identified subject. I authorize Howell PAL, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Howell PAL may use such photographs of my child with or without their name for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I have read this Howell Police Athletic League Participation Waiver and fully understand its terms. By signing this Waiver I acknowledge that I have done so both freely and voluntarily. This signature is to certify that I, as a adult participant or the parent/guardian with legal responsibility for this participant who is a minor, consent to the above mentioned and agree to his/her release, and also agree for myself/ourselves, my/our heirs, assigns and next of kin, to release and indemnify the Howell PAL from all liability, incidents to my /our child s involvement as stated above. X Parent/Guardian Signature Date Signed

PAL ADVANCED GOLF CAMP

PAL ADVANCED GOLF CAMP Date July 16 th July 20 th 2018 July 16 th 9am- 12pm Refresher at Eagle Oaks Golf & Country Club July 17 th 20 th 6:00pm to Dusk at Cruz Farms Golf Club (NO makeups unless multiple