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......Girls & Boys Midnight Basketbal, Friday's only April 5 thru May 17, Gospel Lighthouse Church...... 2013 Spring Activity Schedule, every Tues Wed & Thurs ..... Check Activity Calendar for all Events.......

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"The Size of our Participants may vary but the size of our Commitment remains the same"


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On-Line Participation Application Form


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 Application for Activities

Please complete by filling in all applicable fields and clicking Submit below.

 Use the "tab" key to move to next field.


Name:   Nickname:

Grade as of Sep. 08:   Age:   Sex:   Number of Years Played:


City:   State:   Zip:


Parent/Guardian Name:

E-Mail Address:

Home Ph:   Work Ph:   Cell Ph:

Addt'l Emergency Contact:   Relationship:

Home Ph:   Work Ph:   Cell Ph:

Family Doctor:   Doctor's Phone:

  ALLERGIES: (List all known)

Medication - Allergen:   Reaction:   Management:

Food - Allergen:   Reaction:   Management:

Other - Allergen:   Reaction:   Management:

  MEDICATIONS BEING TAKEN: Please list all medications (incl. over the counter or non prescription drugs) taken routinely. Bring enough

  medication to last the entire camp. Keep in the original packaging that identifies the prescribing physician (if prescription) and name of the medication

  This person takes NO medications on a routine basis (select one)  Yes     No

 This person takes medications as follows:

     Med 1:   Dosage:

           Frequency of Dosage:   Reason for taking:

       Med 2:   Dosage:

           Frequency of Dosage:   Reason for taking:


Name of Local Sponsoring Organization:

Name of Camp Program:   Date:   Time:

2nd Camp Prog. (if applicable): Date: Time:

  EQUIPMENT:  Select one, if applicable

Shirt Size:               Pant Size:   

Check Activity: Football, Basketball, Boxing, Soccer, Cheerleader, Baseball, Other

This release is made to allow my child to participate in Dallas Police Athletic League Camps and its sponsored events. I recognize that my signature on this release is a condition of your permitting my child to participate. I agree that you may photograph and/or videotape my child during camp and its sponsored events and that you retain the rights to use these visual images in any manner you wish without compensation to my child. I further agree that you may use and license others to use my child’s name, voice, likeness, and any biographical facts which may have been provided to you, including advertising and promoting the camp and its sponsored events. I certify that my child is in excellent physical health, and may participate in strenuous and hazardous physical activities, including various sports offered. I certify that there are no physical limits to my child’s participation in the camps and their sponsored events. Permission is granted for my child to receive emergency medical treatment if needed. I hereby release and discharge the Dallas Police Athletic League., and all their affiliated entities from any and all liability, claims, demands, and causes of action for personal injury, property damage, and / or other loss suffered by my child in connection with his / her participation in the camps and their sponsored events.

By clicking "Submit" below I represent that I am a parent / guardian of the minor named above and I agree that the grant and release contained therein binds me and the minor to all of its terms.



                                                                Official Use Only (please check)

                 Age Confirmation     Grade and Academic Confirmation