P.L.A.Y. Application

Please fill in the form below:

Family Information

Activity Information

Please send in applications ahead of time for seasonal activities.

Referral Agency if Referred

Waiver and Release of Medical Information

To be completed by Parent/Guardian:

I, , on behalf of my heirs, executors, assignors, and administrators, release the Human League Association from all claims, demands, or actions arising from my child/youth participating in the PLAY Program. I understand the Human League Association is not legally responsible for any injury, loss, or damage I or my child/youth may sustain while participating in a program sponsored by the PLAY Program. Furthermore, I understand that at some time, the PLAY Program Coordinator may need to discuss the mental and/or physical health of my child/youth with the Recreation Provider and hereby authorize the PLAY Program Coordinator to do so.

Release of Financial Information

To be completed by Parent/Guardian:

I, , authorize the above Referral Agency (specified above) to release personal financial information as required for determining the eligibility of my child/youth in the PLAY Program. I further authorize the PLAY Program to collect this information.

PLAY funds provided in part by:

Volunteering