Richmond Police Activities League Youth Membership Application
2200 Macdonald Avenue, Richmond, CA  94801  |  Phone: (510) 621-1221 
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If membership is accepted, the membership fee is $30 per calendar year per youth. The fee is not prorated for a partial year. Membership acceptance is determined following completion of the Richmond PAL orientation and assessment. You will be notified if your application has been accepted.  No fee is due until notification of acceptance is determined. Please submit one form for each youth.
No Refunds. No Personal Checks. Cash, Money Order, Visa/MasterCard are the only accepted forms of payment. Membership is valid from the date of membership acceptance through the calendar year-end date of December 31.  Some programs may have additional fees.  A copy of the youth's birth certificate must be on file at Richmond PAL.

PLEASE NOTE: All application questions with an asterisk (*) require an entry or the application will not progress and cannot be submitted online. If you have no entry for a required field, you may enter 'N/A'.
Youth's First Name *
Youth's Last Name *
Youth's Birthdate *
MM
/
DD
/
YYYY
Youth's Gender *
Youth's Address (include City, State, and Zip Code) *
Youth's Home Phone Number *
Youth's Mobile Phone Number
Youth's Email Address
Youth's Ethnicity *
Name of School youth is attending currently *
Grade/Level in School *
Any Medical Condition and/or Medication Needed (Please list) *
Total Number in Household *
Household Annual Income: *
Household Type *
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