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  • Placer Sheriff's Activities League Membership Registration Form

    Placer Sheriff's Activities League Membership Registration Form

    Please complete the following form. A confirmation email will be sent to you after submission. Ages 8-17 only.
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  • If your child is over the age of 13, please provide your child's email address and phone number for communication purposes.

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  • Health Information

  • Parental Consent, Insurance Notification, and Medical Treatment

  • I/we, the parents/guardians of {fullName3} for membership in PLACER SHERIFF'S ACTIVITIES LEAUGE (PSAL), hereby give my/our approval to his/her participation in any and all PSAL activities during the current season. I/we do hereby assume all risks and hazards incidental to such participation including transportation to and from activities. I/we do hereby waive, release, absolve, indemnify and agree to hold harmless, the County of Placer, PSAL, the respective sanctioning associations, organizations, or leagues and the organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities, for claims arising out of injury to my/our child.  PSAL has group accident insurance coverage for medical and hospital expenses, with a deductible for each accident. The insurance is secondary when there is any other valid and collectible insurance provided by parent/guardian. Limited coverage is provided for any one accident with limited dental coverage for sound, natural teeth. A copy of the policy is available for inspection at the PSAL office. In signing the foregoing release, I/we acknowledge that: (1) any claim for medical service which arises out of an injury must be reported to a PSAL league official within thirty (30) days of the date of injury; (2) I/we have read the forgoing release, understand it and signed it voluntarily. I/we further understand that any registration fee or other sums paid does not constitute a direct premium payment for insurance.

    In the event of injury to {fullName3}, I/we hereby grant authority to a qualified physician to render such medical treatment as said physician deems necessary under the circumstances. I/we, the Parents/Guardian of the above named PSAL candidate have read and understand the above Parental Consent, Insurance Information Clause, and Medical Treatment Authorization. 

    I, the parent/guardian of {fullName3}, agree to allow my child to participate in the activity listed in my child’s registration form including associated travel.

    I am aware these activities can be inherently dangerous and I am voluntarily allowing my child to participate in teh activities with knowledge of risks involved, both expected and unexpected and hereby agree to accept an and all risks or injury to death.

    In return for the benefits from my child’s participation, I agree not to sue and release and hold harmless the County of Placer, PSAL, their officers, directors, employees, agents and volunteers from any liability for any loss, injury, or death connected with my child’s participation in the activity except for loss, injury, or death caused intentionally or by willful misconduct.

    The Placer Sheriff’s Activities League reserves the right to photograph facilities and program participants for promotional purposes. On behalf of my child, I agree to the use of any such photographs in which he/she may appear. Photographs may be used in brochures, displays with press releases, on the County of Placer website, any social media website, or the PSAL website. Individuals may submit their photos for consideration.

    This release is intended to protect the County of Placer, The Placer Sheriff's Activities League, their officers, directors, employees, agents, and volunteers from claims of negligence. However, this release is not intended to exempt them from responsibility for willful or intentional acts or omissions which result in loss, injury, or death. I have carefully read this Release of Liability and Assumption of Risk Agreement. I fully undersand its contents and implications. I am aware that this is a Release of Liability, Hold Harmless Agreement and Assumption of Risk Agreement and that it is a leagally binding contract between The County of Placer, The Placer Sheriff's Activities League, myself, and {fullName3}. I further understand that this release is binding on my heirs, personal representatives, next of kin, spouse, domestic partner and assigns. I sign this agreement of my own free will.

     

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  • Auburn Interfaith Food Closet

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  • Additional Household members (for each additional person in the household)
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  • CERTIFICATION AND LIABILITY RELEASE: I certify that the information on this registration form is true, and I understand that I may receive food a maximum of once every 30 days (Homeless persons can receive reduced quantities once per week). I understand that the Auburn Interfaith Food Closet is a charitable organization which receives and distributes donations of food. The Auburn Interfaith Food Closet makes no representation as to the quality or condition of the food, and disclaims all warranties, expressed or implied by law, as to the fitness of such. The persons or organizations receiving such food from the Auburn Interfaith Food Closet agree not to hold the Auburn Interfaith Food Closet liable for any damage to persons or property caused by the condition or quality of the food.

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  • Code of Conduct/ Daily Rules

  • Welcome to the Placer Sheriff's Activities League (PSAL). Our activities are offered for your enjoyment. Your cooperation and sportsmanship are essential to the overall success of the program. All participants, parents, coaches, managers and spectators are expected to act in an acceptable manner during the entire program. The PSAL reserves the right to take any disciplinary action it deems appropriate against the participants, parents, coaches, managers and spectators not acting in and acceptable manner, including but not limited to suspension from an activity, expulsion form the facility, and prohibition from participating in any future programs. The benefit a participant derives from this program depends very much on the participant’s conduct and the conduct of the participant’s parents or guardians.

    All participants in PSAL programs and their parents or guardians are required to comply with the following:

    • If you have an active virus or infection, do not attend PSAL
    • Show respect to parents, PSAL staff, coaches, teachers, spectators, and other participants
    • Will not use profanity and/or engage in inappropriate behavior
    • Will not wear clothing that glorifies criminal activities, profanity, substance use, or sexaul content. No provocative clothing
    • Will be a good citizen 
  • The following are the rules set forth by the Activities League staff.
    All participants in the PSAL program are required to comply with the following:

    • PARTICIPATE and be on time
    • No profanity, no running except where allowed, no yelling or screaming
    • Respect your surroundings, pick up after yourself
    • Listen and be respectful to all PSAL staff 
    • Follow and comply with PSAL staff instruction
    • Respect your peers and keep PSAL a safe place (no bullying, ridiculing, fighting or horseplay will be tolerated)
    • No clothing or accessories that glorify criminal activity, profanity, substance usage, or sexual content. No provocative clothing
    • Cell phone use is limited to appropratie place and time

    Failure to follow any of these rules is subject but not limited to the following consequences at the direction of any PSAL staff: suspension from the program for a period of time, and/or termination from the program.

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  • A Concussion Fact Sheet

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  • Parent Signature

  • By signing below, I agree that yearly fees are $25 valid through a complete calender year of payment. I understand no refunds will be issued after membership approval. 

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