Please fill in the form below:

    Family Information

    How many people are there in your family (living at home). Please include yourself:
    How do you prefer to receive updates and information?
    Is this child/youth presently under:
    Do you want to receive emails regarding events that are happening in the City?
    Does this child/youth have any medical concerns (psychological or physical)?
    Is this child/youth presently enrolled in a Recreational Activity, such as music lessons, membership at the YMCA, in a sport, or involved in another activity?

    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

    Are you willing to volunteer for the PLAY Program?
    How?


    The Human League Association aims to remove social and economic barriers faced by families here in Sudbury. We reach out to the most vulnerable members of our society and guide them towards happier, healthier and more productive lives.

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