Orange Police Athletic League
In partnership with The City of Orange Police Department
Tell us about your child
Are you a parent that need help with your child and
do not know where to start?
We do not promise or guarantee anything, but will be happy to provide you with information on services or programs that may assist you.
©Orange PAL 2006. All Rights Reserved. Designed and updated by BRH
Orange Police Department
29 Park Street
Orange, NJ 07050
Phone: 973-266-4111 Ext. 5043
Fax: 973-674-4008
E-mail: info@orangepal.org
www.orangepal.org
Information listed here is used to help us better assist you. We do not sell your information. However, if your child requires medical or other professional help please report it to the appropriate authorities.
Required fields are indicated by an • 59
Parent’s First Name:•
Parent’s Last Name:•
Street Address:
City:•
State:•
Zip / Postal Code:•
Country / Province:
Primary Phone:•
Alternate Phone:
Email Address:•
Child's Name:●
sex:
Child's Age:•
Date of Birth:
Child’s Grade:•
School: Orange Middle Orange High Main Street Heywood Avenue Oakwood Avenue Central Elementary Cleveland Street Orange Alternative Forest Street Lincoln Avenue Park Avenue Other
How did you hear about us?
Search Engine / Web Ad Educational Consultant Print Advertisement Clinical Professional/Therapist School Parent Hospital or Doctor TV/Radio Other policedepartment church
Is your child involved in a gang?
No Yes What Gang?
Is smoking, drugs, and alcohol involved?
No Yes What kind?
Have your child ever been arrested?
No Yes For what?
How long have you been having problems?
are both parents involved?
If a person referred you, please tell us their name:
Please briefly describe the issues or problems that are causing you concern:
