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 websites at www.oceancitymd.gov and www.camps.oceancitymd.gov
Mail or fax this registration form to the mailing address and/or fax number above
REGISTRATION FORM
Participant’s
Last Name First Name
M/F Age Grade Birthdate Program
Number
Program
Description
Price
Please check all that apply OC Resident (OCR) Town Employee (OCE)
Worcester County Resident (WCR) OC Property Owner (OCL)
OC Volunteer Firefighter (OCF) Non- Resident (NR)
Parent, Guardian, or Adult Participant Information:
Last Name: ___________________________________ First Name: ________________________________
Mailing Address: _________________________________________________________________________
Street City State Zip Code
Ocean City Property Address: ______________________________________________________________
Home Phone: _________________Work Phone: __________________ Cell Phone: __________________
E-mail Address(s): ________________________________________________________________________
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 & Phone Info: _____________________________________________________
Name Phone
If faxing in your registration, please contact our office at 410-250-0125 with payment information or
provide number below:
Credit Card Number__________________________________ Exp. Date_____________________________
Would you be interested in becoming a sponsor? _______________ and/or volunteer? ________________________
Make Checks Payable to: TOWN OF OCEAN CITY Total Amount Enclosed: __________________________
How did you hear about our programs? (Check all the apply) Town of OC Website or Affiliated Link Television
Newspaper Radio Other Website School Flyer Recreation Dept Brochure
Other__________________________
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 or videoed for publicity purposes.
Please Note: Due to the strenuous nature of some activities, the participant is urged to consult his or her physician
concerning fitness 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.camps.oceancitymd.gov