Danbury P.A. L
Summer
Experience
Children from Pre-K - 6th Grade
8 Weeks Available:
Week 1: June 22nd-June 26th
Week 2: June 29th-July 3rd
Week 3: July 6th-July 10th
Week 4: July 13th- July 17th
Week 5: July 20th-24th
Week 6: July 27th-July 31st
Week 7: August 3rd- August 7th
Week 8: August 10th- August 14th
Regular Day: 9 am to 3 pm
Extended Day: 8 am to 4 pm
Price per Week for Regular Day: $165
Price per Week for Extended Day: $215
Join us for a Safe and
Active Summer Experience
that Allows Kids to Pick
Activities they Enjoy.
Program Offers Daily
Access to Candlewood Lake
for Summer Fun in Sun,
Lake, and Sand.
Registration Open: April 1st
Registration Form Available @
www.danburypal.org
*Multiple Child Discount Available
**HEALTHY CHOICE THEMED WEEKS **
Each week a different topic will be highlighted
with activities & speakers (ex. Teamwork,
sportsmanship)
For More Information
Please Contact P.A.L.
Phone: 203-778-4725
Or visit danburypal.org
Danbury P.A.L Summer Experience Registration Form
Please Print As Neatly As Possible
Child Information:
Name:____________________________________________________________________________________________
Address:________________________________________________________City:_______________________________
Grade (Fall 2015):_____________ School: _____________________________Town:____________________________
List Any Medical Problems or Information :______________________________________________________________
______________________________________________________________________________________________
Parent Information:
Name:_____________________________________________E-Mail:_________________________________________
Phone: Cell:____________________________Home:___________________________Work:______________________
Best Number During Day Hours? _____________________________________________________________________
Emergency Contact Information:
Name:__________________________________________ Phone #:___________________________________________
Relationship :____________________________________________________________________________
To induce the Danbury Police Activities League Inc. to accept registration and permit participation by the above named minor child, I hereby give my
permission and consent, agree to release, indemnify, and hold harmless the Danbury P.A.L, its officers, staff, and representatives from any claims arising from
any injury to above named minor. I hereby give my consent for emergency care prescribed by duly licensed Doctor of Medicine or Doctor of Dentistry. This
care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
I agree to pay all registration fees on timely basis. A fee of $25 will be charged for each returned check
Signature (Parent/Guardian):___________________________________________________________________________
Fee Structure: Please Check Appropriate Fee___$165 per Week (9 am to 3 pm)
Registration Due Thursday Prior to Start of Week
___$215 per Week (8 am to 4 pm)
$20 Extra Charge for Registration on First Day of Session
***Multiple Child Discount: $25 Off per Family per Week
No Refunds
Session Schedule: Please Check Appropriate Week___Week 1: June 22nd-June 26th
___Week 5: July 20th- July 24th
___Week 2: June 29th-July 3rd
___Week 6: July 27th-July 31st
___Week 3: July 6th-July 10th
___Week 7: August 3rd- August 7th
___Week 4: July 13th- July 17th
___Week 8: August 10th- August 14th
Please Make Checks Payable to Danbury P.A.L
Amount Due:__________________________________Cash:__________________ Check #:__________________
Return to : Melisa Fracker, Camp Director- Danbury PAL – 25 Hayestown Rd Danbury 06811