Wayne PAL

Camper Information

Camper Name

Register for the weeks you will be attending.
Full Day - 7:30am-6:30pm
Early Day 7:30am-3:30pm
Week 1( 6/26-6/30)
Week 2( 7/3-7/7)
Week 3( 7/10-7/14)
Week 4( 7/17-7/21)
Week 5( 7/24-7/28)
Week 6( 7/31-8/4)
Week 7( 8/7-8/11)
Week 8( 8/14-8/18)
Week 9( 8/21-8/25)

Household / Adult Primary Contact

Relationship to Participants: *

Medical Release Form

Emergency Phone #'s
Additional Contact (other than a Parent)
Professional Medical Information

In the event of an emergency I hereby give permission, of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.

In consideration of acceptance of my child in the Wayne PAL Summer Day Camp. I hereby, for myself, my child, their heirs, executors, and administrators waive and release any claim we may have for damages against the Wayne PAL, its officials, officers, employees or representative, the Wayne PAL board of trustees, its officers, employees or representative or their successors of assigns for any and all injuries, except those specifically covered under the PAL Youth Activity Accident Insurance policy, that may be suffered by my child while participating in sports events or programs or activities of the Wayne PAL.
Sign Here with mouse *
Please continue to next page to make payment. You must pay for at least one week to complete registration. You will then be able to pay week by week as required. Also, YOU DO NOT NEED A PAYPAL ACCOUNT TO MAKE PAYMENT. Continue to payment page and click "pay by credit card" link.