Release Of Liability And Assumption Of Risk Agreement (Minor) Page 3
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4(Please read, sign, and attach the PSAL Code of Conduct.)
Name:_________________________________________________________________
Date of Birth:___________________________________________________________
Ethnicity (Race):_________________________________________________________
Gender (Male/Female):___________________________________________________
Residence (Address):_____________________________________________________
School:________________________________________________________________
GPA:__________________________________________________________________
PSAL Start date:_________________________________________________________
Referral Type (Court, Probation, etc):________________________________________
On probation (Yes/No):___________________________________________________
Prior Arrests (Yes/No) and Date if yes:_______________________________________
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