RECREATION REGISTRATION FORM MAIN CONTACT (18 YEARS +) Last Name
First Name
Birth Date (mm/dd/yyyy)
Gender
Street Address
City
Home Phone
ZIP
State Cell Phone
Work Phone
PAYER INFORMATION (If different than Main Contact) Last Name
Home Phone Street Address
PARTICIPANT’S NAME (Last, First)
City
Birth Date (mm/dd/yyyy)
Check or Money Order (payable to MCR) VISA
Please check if this is a new address/ phone/email.
First Name
ZIP
State
Gender (M/F)
CLASS/ACTIVITY Number
Title
Location
Fee
Non-County Residents include an additional $15 per participant, per activity.
MasterCard
Cardholder Name (print)
Number
Signature
Date
Program Fee Total
Exp.
Mail to: MCR, attn: Registrar, 4010 Randolph Road, Silver Spring, MD 20902 For registration assistance, please call (240) 777-6840.
FAX to: (240) 777-6818 (Credit Card Payment Only)
Online: recweb.montgomerycountymd.gov
The participant assumes all risks associated with participation in the program; the County assumes no liability for injury or damages arising from participation in the program. Due to the strenuous nature of some activities, the County encourages each participant to consult his or her physician concerning fitness to participate in the program. The participant consents to emergency treatment. The participant also consents to the County’s use of the participant’s image and likeness as shown in any photographs, videotapes, motion picture film, or electronic images and any audio recordings made of the participant’s voice in whatever way the County desires, including television print and Internet websites. Furthermore, the participant consents that such photographs, films, recordings, electronic images shall be the sole property of the County. If the participant is a minor, the parent of guardian approves his or her participation in the program. Neither the instructor nor any staff are responsible for children prior to or after scheduled program.
Participant or Parent/Guardian Signature
Date
PARKS REGISTRATION FORM MAIN CONTACT Last Name
First Name
Birth Date (mm/dd/yyyy)
Gender
Street Address
City
Home Phone
State
ZIP
Cell Phone
Work Phone
PAYER INFORMATION (If different than Main Contact; no third-party payments or credit cards, please) Last Name
Home Phone Street Address
PARTICIPANT’S NAME (Last, First)
Please check if this is a new address/ phone/email.
First Name
City
Birth Date (mm/dd/yyyy)
Gender (M/F)
State
Title
ZIP
CLASS/ACTIVITY Number
Location
Fee
Program Fee Total Save time and money! Register online at ParkPASS.org. To register for a Parks class using this form, fill in the Parks section completely, make your check or money order payable to M-NCPPC, and mail or bring both to the ParkPASS facility offering the course(s) you’d like to take. See the Parks Directory in this Guide for facility locations, or visit www.MontgomeryParks.org for more information. For help with Parks courses or registration, call us at (301) 495-2580 M-F, 10am-2pm. The participant assumes all risks associated with participation in the program; Montgomery Parks/M-NCPPC assumes no liability for injury or damages arising from participation in the program. Due to the strenuous nature of some activities, Montgomery Parks/M-NCPPC encourages each participant to consult his or her physician concerning fitness to participate in the program. The participant consents to emergency treatment. The participant also consents to Montgomery Parks/M-NCPPC’s use of the participant’s image and likeness as shown in any photographs, videotapes, motion picture film, or electronic images and any audio recordings made of the participant’s voice in whatever way Montgomery Parks/M-NCPPC desires, including television print and Internet websites. Furthermore, the participant consents that such photographs, films, recordings, electronic images shall be the sole property of Montgomery Parks/M-NCPPC. If the participant is a minor, the parent of guardian approves his or her participation in the program. Neither the instructor nor any staff are responsible for children prior to or after scheduled program.
Participant or Parent/Guardian Signature
Date