Fillable REGISTRATION FORM PROGRAMS, EVENTS & CAMPS (Commissioners of Carroll County, Maryland)

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REGISTRATION FORM PROGRAMS, EVENTS & CAMPS (Commissioners of Carroll County, Maryland)

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U.S.A. forms for Commissioners of Carroll County, Maryland

BROWSE COMMISSIONERS OF CARROLL COUNTY, MARYLAND (MD) FORMS

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REGISTRATION FORM
PROGRAMS, EVENTS & CAMPS
/ /
PARTICIPANT’S LAST NAME FIRST NAME DATE OF BIRTH
PARENT/GUARDIAN’S NAME (if applicable)
STREET ADDRESS
CITY STATE ZIP CODE
PHONE (home) PHONE (work or cell)
EMAIL ADDRESS
EMERGENCY CONTACT NAME EMERGENCY PHONE (Is this a cell phone? Yes No)
Program Name Program # # Aending Per Person Fee Total $
$ $
$ $
$ $
$ $
Comments/Special Instrucons
SUBTOTAL
$
Membership discount applied
-
TOTAL $
Make checks payable to Carroll County Commissioners and mail to:
Carroll County Department of Recreaon and Parks
300 S. Center Street
Westminster, MD 21157
See the reverse of this form for the Waiver of Liability and Authorizaon for Use of Photographic Likeness.
Save a stamp, register online at ccrecpark.org or call 410-386-2103 • Don’t forget to read & sign the back!
v.20200617
Carroll County Department of Recreation and Parks
WAIVER OF LIABILITY, COVID-19 INFORMATION &
AUTHORIZATION FOR USE OF PHOTOGRAPHIC LIKENESS
WAIVER OF LIABILITY, COVID-19 INFORMATION &
AUTHORIZATION FOR USE OF PHOTOGRAPHIC LIKENESS
Waiver of Liability
I, in my legal capacity as parent/legal guardian of the minor(s) named on the
Carroll County
Department of Recreaon and Parks Registraon Form
, or as a parcipang adult over the age of
eighteen (18), recognize and acknowledge that there are certain risks of physical injury, property
damages and expenses which my child(ren) or I may sustain as a result of parcipang in this Program.
I further agree on behalf of the minor(s) named on the
Carroll County Department of Recreaon
and Parks Registraon Form
or myself, heirs, representaves, executors, administrators and assigns
to assume all risk and agree to fully release, discharge, indemnify, hold harmless and defend Carroll
County Government and its employees, volunteers, agents, and servants from any and all claims for
personal injury, property damage, death or accident of any kind arising out of or in any way related to
the parcipaon in the Program, however the injury or damage occurs.
COVID-19 Informaon
I, on behalf of my child(ren) or myself, acknowledge and understand that the novel COVID-19 virus is
an extremely contagious virus and is believed to be spread mainly from person to person contact and
that the Carroll County Government does not warrant or guarantee that you, your child(ren), your
spouse, or anyone else will not be exposed to or infected with the COVID-19 virus as a result of my or
my child(ren)’s parcipaon in the Program. I have independently evaluated the risks of being exposed
to or infected by the COVID-19 virus and have determined to parcipate or allow my child(ren) to
parcipate in the Program. Finally, understanding those risks, I, for myself, my child(ren), my spouse, or
legal representaves, heirs, and assigns, hereby agree to assume full responsibility and liability for the
risk of bodily injury, illness, permanent disability, and/or death which may result from exposure to or
infecon with COVID-19 before, during, and aer parcipang in the Program. Due to the strenuous
nature of some acvies, the parcipant, or if the parcipant is a child, the child(ren)’s parent or
guardian is encouraged to consult with a physician concerning the parcipant’s tness to parcipate in
the Program.
Authorizaon for Use of Photographic Likeness
I agree to allow the Carroll County Department of Recreaon and Parks to take and ulize photographic
images of the registered individual(s) for the purpose of promong and publicizing of the Department’s
programs and/or events. If I prefer to not allow the above registered parcipant(s) to be photographed,
I will call 410-386-2103 to register my request.
/ /
PARTICIPANT’S SIGNATURE DATE
Parent(s) and/or Legal Guardian(s) signature if parcipant is under the age of 18.
PRINTED NAME
v.20200617
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REGISTRATION FORM PROGRAMS, EVENTS & CAMPS (Commissioners of Carroll County, Maryland)

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Completed 1 April 2021

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