DO NOT USE THIS FORM FOR ONLINE REGISTRATIONS!
THIS FORM IS ONLY FOR GENERAL INFORMATION & OFFLINE REGISTRATIONS
INDIVIDUAL PROGRAMS MAY REQUIRE ADDITIONAL INFORMATION
COMPLETE & PRINT THIS FORM, APPLICANT MUST SIGN ALL SIGNATURE LINES.
You must also provide your Insurance Information and an Emergency Phone Number.
Send or bring this Completed Form and Proof of Applicant Age (Along with your Payment, if required) to:
San Jose Police Activities League, 680 South 34th Street, San Jose, CA 95116
ADULT Registration - SJPD PAL FOR Program: ______________ DATE: _______

Applicant NAME: ____________________  DATE OF BIRTH: ________  Program AGE: __
ADDRESS: _________________________________________________________________
HOME PHONE: ____________  EMAIL Address: __________________________________
GENDER □ MALE □ FEMALE    Returning Player:□ YES □ NO
Program Specific Information: __________________________________________________
(APPLICANT RACE OR CULTURAL BACKGROUND FOR STATISTICAL PURPOSES ONLY)
□ Caucasian/European/American □ African/American □ Mexican/American or Latin □ Asian/American □ Other

I understand that no refunds will be issued after uniform or equipment is received. I will be responsible for transporting myself to all practices and games.

APPLICANT NAME: ____________________  SIGNATURE: ______________________  DATE: ____________

SAN JOSE PAL ADULT CODE OF ETHICS

The ADULT(S) will:

In addition to abiding by the above Code of Ethics, all ADULTS MUST:
UNDERSTAND THAT ANY VIOLATION OF THE CODE OF ETHICS, OR CRIMINAL INVESTIGATION, MAY RESULT IN ACTION BY THE PAL OFFICE, RANGING FROM: NOT BEING ALLOWED TO ATTEND, PARTICIPATE, AND/OR SPECTATE AT ANY OF THE SAN JOSE PAL PRACTICES OR GAMES AND/OR LEGAL ACTION TAKEN FOR THE UNLAWFUL CONDUCT.
SEASON (YEAR): _______

APPLICANT NAME: ____________________  SIGNATURE: ______________________  DATE: ____________

PAL PUBLICITY RELEASE

I hereby grant to the San Jose Police Activities League, the worldwide and perpetual right and authority to use, reproduce, distribute, broadcast or otherwise transmit, publish and display in whole or in part, my name, photograph, or any other likeness and/or biographical information I may provide, and any statement I have made or may make concerning the PAL Program in any and all media now known or hereafter invented, in perpetuity, for the purpose of trade, promotion and/or otherwise without compensation or additional consideration, except where prohibited by law.

APPLICANT NAME: ____________________  SIGNATURE: ______________________  DATE: ____________

ADULT CONSENT, INSURANCE, MEDICAL TREATMENT AUTHORIZATION CLAUSE

I, the above named Applicant for a position on a SAN JOSE PAL Team, hereby give my approval to my participation in any and all PAL activities during the current season. I do hereby assume all risks and hazards incidental to such participation including transportation to and from the activities; and I do hereby waive, release, absolve indemnify and agree to hold harmless, the PAL, the Respective Association or Organization, League, and SAN JOSE PAL, the organizers, sponsors, supervisors, participants, and persons transporting myself to and from activities, or any claim arising out of injury to myself.

PAL has group Accident Insurance Coverage for medical and hospital expenses, with a given deductible amount for each accident incurred.  The PAL insurance is considered as secondary coverage, when there is any other valid and collectible coverage provided by myself. Limited coverage is provided for any one accident with a given limited dental coverage for sound, natural teeth.  In executing the foregoing release, I, the undersigned, hereby acknowledge and represent that:  (A)  I, understand that any claim for medical service which arises out of injury must be reported by A LEAGUE OFFICIAL WITHIN TWENTY DAYS of the date of injury;  (B)  I have read the foregoing release and understand it, and sign it voluntarily;  I understand that any Registration Fee or other sums paid does not constitute a direct premium payment for insurance.
Do you have Health/Group Medical Insurance: YES ( ) NO ( ) (Provide Insurance Information):

Carrier: ______________________________ Plan # ___________ or MEDI-CAL # ___________
In the event of injury or illness to myself, ____________________, I hereby grant authority to a qualified physician to render such Medical treatment as said physician deems necessary under the circumstances.
I, the Applicant have read and understand the above Consent Clause, Insurance Information Clause, and Medical Treatment Authorization Clause. By signing this Registration Form, I recognize the above claims and do hereby grant permission for myself to participate in all officially recognized PAL activities.

APPLICANT NAME: ____________________  SIGNATURE: ______________________  DATE: ____________
Emergency Phone Number: ______________  Relationship: _________________ Home Phone: ____________

RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK AGREEMENT

I, the undersigned Applicant, agree to allow myself participate in the activity listed in my registration form, including associated travel. I am aware that this activity is potentially dangerous and am voluntarily allowing myself to participate in this activity with knowledge of the risks involved, both expected and unexpected, and hereby agree to accept any and all risks loss or injury or death. APPLICANT MUST INITIAL HERE: __________
In return for the benefits from my participation, I agree not to sue and hereby release and agree to hold harmless the City of San Jose, its employees, its agents, and any volunteers working with the City for and from liability and responsibility for any loss or injury or death connected with my participation in the activity except for loss or injury or death caused intentionally or by willful misconduct.
This release is intended to protect the city, its employees, its agents, and any volunteers working with the city from claims of negligence (the failure to use reasonable care). However, it is not intended to exempt them from responsibility for their willful or intentional injury to the person or property of another. I have carefully read this agreement and fully understand its contents.
I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, HOLD HARMLESS AGREEMENT, AND ASSUMPTION OF RISK AGREEMENT AND THAT IT IS A LEGALLY BINDING CONTRACT BETWEEN THE CITY OF SAN JOSE AND ME. I FURTHER UNDERSTAND THAT THIS RELEASE IS BINDING ON MY HEIRS, PERSONAL REPRESENTATIVES, NEXT OF KIN, SPOUSE AND ASSIGNS. I sign of my own free will. I have fully read this Agreement and fully understand its content, and the significance of this release of liability and assumption of risk agreement.

APPLICANT NAME: ____________________  SIGNATURE: ______________________  DATE: ____________

THE PLAYERS AGREEMENT IS REQUIRED ONLY FOR JUNIOR GIANTS SENIOR GIANTS PROGRAM
PLAYERS AGREEMENT TO PARTICIPATE IN JUNIOR GIANTS LEAGUE, AND PUBLICITY RELEASE

Participation in all sports and physical activities involves certain inherent risks and regardless of the care taken, it is impossible to ensure the safety of the participant. Baseball is an activity requiring considerable coordination, agility, and a certain level of cardiovascular fitness. It involves many quick bursts of speed and requires being alert to batted balls, thrown balls and thrown bats. Although it is a reasonably safe activity, some elements of risk cannot be eliminated.

A variety of injuries may occur to a baseball participant. Some examples of those injuries are:

These, and other injuries, sometime occur in baseball as a result of hazards or accidents such as slips, tripping, catching the ball, being struck by a ball, being struck by a bat, colliding with another player, colliding with the wall, fence or on a base or at home plate, or falling on the field.
To help reduce the likelihood of injury to yourself and to other participants, participants are expected to follow the following rules:

I agree to follow the preceding safety rules, all posted safety rules, and all rules common to the sport of baseball. Further, I agree to report any unsafe practices, conditions, or equipment to my coach or umpire.
I certify that (1) I possess a sufficient degree of physical fitness to safely participate in baseball, and (2) I understand that I am to discontinue activity at any time I feel undue discomfort or stress.

I have read the preceding information and it has been explained to me. I know, understand and appreciate the risks associated with participation in baseball and I am voluntarily participating in the activity. In doing so, I am assuming all of the inherent risks of the sport. I further understand that in the event of a medical emergency, I will be financially responsible for any expenses involved.

PUBLICITY RELEASE: I hereby grant to the San Francisco Giants and the Giants Community Fund, the worldwide and perpetual right and authority to use, reproduce, distribute, broadcast or otherwise transmit, publish and display in whole or in part, my name, photograph, or any other likeness and/or biographical information I may provide, and any statement I have made or may make concerning the Junior Giants League in any and all media now known or hereafter invented, in perpetuity, for the purpose of trade, promotion and/or otherwise without compensation or additional consideration, except where prohibited by law.

City: SAN JOSE PD PAL  Age of Participant ___
PRINTED FULL NAME: ____________________  SIGNATURE: ______________________  DATE: ____________