Sample forms for permission-- A = General, B = Much more specific. Change parts as necessary...
A. Registration Form for _____________________
The Session will run from _________ until ____________ on _________________
Classes will be held from _____________, ___________ until ______________, ______
I will take responsibility for picking my child up promptly at ________________.
Signed__________________________
Date____________________________
Albany PAL Chess Club (All Public, Private and Parochial Schools Grades 4-8
After School from February until May.
Tournament on June 5 (Mon, Rds 1 & 2) and Finals June 6 (Tues., Rds 3 & 4, Awards)
This program is a coordinated effort between Albany Police Athletic League and your child’s school. Participants will compete and learn the game of chess on a weekly basis at their school in an after-school program. The program will culminate with a city-wide chess tournament and pizza awards ceremony at the VI Community Center, 844 Madison Ave., Albany. Participants will receive weekly instruction in chess, a t-shirt, snacks and awards. Transportation for this activity is your responsibility.
Name___ Date of birth___ Address ___ School ___ Parent / Guardian___ e-mail ___ relationship ___ telphone (H) ___ (W)___
(For more information call Sgt. Leonard Ricchiuti or Jacqueline Smith @ the PAL Center 435-0392.)
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, in particular, the after school chess club. 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 literature.
Parent / Guardian Signature:___ Hospitalization Plan ___ Policy # ___ Allergies ___ Doctor ___ Doctor’s telephone___
Person to be contacted in case of injury, if parent or guardian is unable to be contacted:
Name___________ Phone #____