HOWELL POLICE ATHLETIC LEAGUE
Track Club Application

NAME_______________________________ HOME PHONE_________________

ADDRESS_________________________ CITY________________STATE_________ZIP_________

DOB __/______/______AGE_____SCHOOL ATTENDING______________________GRADE_____

PARENT INFORMATION

MOTHER______________________________ HOME PHONE_____________________

ADDRESS___________________________ CITY______________STATE_________ZIP__________

OCCUPATION_______________________EMPLOYER____________________________________

WORK PHONE______________________BEEPER/CELL___________________________________

INSURANCE CARRIER_______________________________________________________________

FATHER______________________________ HOME PHONE_____________________

ADDRESS___________________________ CITY______________STATE_________ZIP__________

OCCUPATION_______________________EMPLOYER____________________________________

WORK PHONE______________________BEEPER/CELL___________________________________

INSURANCE CARRIER_______________________________________________________________

** MEMBERSHIP FEE OF $30.00 MUST ACCOMPANY THIS APPLICATION AND ENTITLES THE YOUTH MEMBER TO PARTICIPATE IN HOWELL PAL EVENTS, ALSO INCLUDES A USATF CARD,AND A PAL T-SHIRT.

howellpaltrack@excite.com