OCEAN CITY RECREATION & PARKS DEPARTMENT
200 125TH STREET, OCEAN CITY, MD 21842
Phone 410-250-0125 Fax 410-250-5409 Rain Hotline 410-250-2124
Visit our website: www.oceancitymd.gov and www.ocsportscamps.com
Mail/fax this form to the mailing address/fax number above, or scan and email to: nsimmons@oceancitymd.gov
REGISTRATION FORM
Participant(s) information:
Last Name First Name M/F Age Grade Birthdate Program Program Price
Number escription
Please chec all that apply: OC Resident (OCR)
Worcester County Resident (WCR)
OC Volunteer Fireghter (OCF)
Town Employee (OCE)
OC Property Owner (OCL)
Non-Resident (NR)
Parent, Guardian, or Adult Participant Information:
Last Name: ________________________________First Name: ___________________________________________________
Mailing Address: __________________________________________________________________________________________
Street City MD Zip Code
Ocean City Property Address (if applicable) ________________________________________________________________
Home Phone:_______________________Work Phone:_______________________Cell Phone: ________________________
E-mail address: ____________________________________________________________________________________________
The e-mail information collected will be used only by the Ocean City Recreation Center and will not be sold or forwarded to
other companies and/or sites.
Emergency Contact Name & Number Info ___________________________________________________________________
Might you be interested in becoming a partner(sponsor) ______________ and/or volunteer? _____________________
How did you hear about our programs: (Check all that apply) Town of OC website Other website
Television Newspaper Radio School Flyer Recreation Department Brochure Facebook
Twitter Peachjar Other_______________________________________________________________________
PAYMENT
Credit Card #__________________________________________________________________Exp. Date__________________
Checks Payable to Town of Ocean City
Please call in payment information for all faxed or emailed registrations.
Total Payment: ________________________
WAIVER STATEMENT (MUST BE SIGNED & MUST BE 18 YEARS OR OLDER)
I do for myself, my heirs, and assigns, waive and release any and all claims to damage against the Town of Ocean City Recreation and Parks Department and its
agents or authorized representative(s) conducting the above listed program(s) as a result of any and all injuries incurred by the above listed participant(s) from, or
while participating in said program(s). *Participants may at some time be photographed for publicity purposes.
PLEASE OTE: Due to the strenuous nature of some activities, the participant is urged to consult his or her physician concerning tness to participate. All activities
present certain inherent risks and hazards which the participant is urged to consider and which the participant assumes.
SIGNATURE:_________________________________________________________________DATE:_______________________
phone 410.250.0125 37 www.oceancitymd.gov
/www.oceancitymd.gov
/www.oceancitymd.gov
/www.ocsportscamps.com
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