PAL of Delaware Registration
Fill out the form carefully for registration
Member (Child's) Name
First Name
Middle Name
Last Name
Child's Birthdate
-
Month
-
Day
Year
Date
Child's Gender
Please Select
Male
Female
Non-Binary
Choose not to specify
Child's School
Does your child have a sibling currently attending PAL?
Please Select
Yes
NO
Which PAL are you looking for your child to attend?
Please Select
Garfield Park PAL
Hockessin PAL
Delaware City PAL
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1 Name & Relation
Contact Number
Parent/Guardian 2 Name & Relation
Contact Number
Parent/Guardian 1 Email
Parent/Guardian 2 Email
Authorized pick up personnel (First and Last Names)
Is there any custody arrangements we should know about?
Please Select
No
Yes (please provide copy)
Do you have insurance
Please Select
No
Yes
Name of Insurance and Policy Number
Does your child have any allergies/medical problems/diagnosis'? Please explain
Parent/Guardian Signature
Submit
Should be Empty: