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Maize Recreation Fun Factory Fun Days Registration Form
Return to: MRC, P.O. Box 205, 10100 Grady Ave., Maize, KS 67101
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Name:
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Date of Birth:
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Grade:
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Address:
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City & State:
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Zip Code:
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Home Phone:
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Work Phone:
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Cell Phone:
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E-Mail Address:
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Parent/Guardian:
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Special Medical Information:
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Medications Taken:
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Emergency Name &
Phone Numbers:
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Check Dates to Attend:
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Thursday, Sept. 25
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Friday, Sept. 26
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Friday, Oct. 17
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Friday, Jan. 2
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Monday, Jan. 19
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Thursday, Feb. 5
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Friday, Feb. 6
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Drop-off Time:
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Pick-up Time:
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Payment Options:
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Check (if mailing form in)
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To pay by PayPal, credit card or debit card click the store link on the Online
Registration page
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1. I/We the below signed person/parent(s) having legal custody/legal guardianship of said
minor, give permission for said minor to attend any MRC activities supervised by
authorized MRC staff. Said minor is physically able and mentally prepared to participate
in all activities.
2. I/We do hereby authorize the MRC and MRC staff to transport said minor in Maize USD
266 bus, van, car or other vehicle to/from the site for daily transportation and/or field trips,
emergency care, etc.
3. I/We have read and understand the MRC’s policies concerning discipline and will pass
this information along to my/our child. I/We understand that the MRC reserves the right to
dismiss any child who fails to adhere to MRC Fun Factory rules and regulations.
4. I/We understand fully and will abide by the MRC’s policy concerning drop-off and pick-
up of children. I/We shall be prepared DAILY to present photo ID to on-site staff to
determine my/our identity as authorized persons to pick up my/our child. Further, I/We
shall inform others who are authorized to call for our child to present photo ID when
picking up my/our child.
5. I/We acknowledge that by my signature below, the registrant listed above is
participating in the Maize Recreation Commission programs at his/her own risk. Maize
Recreation Commission, Maize School District, City of Maize, successors and assigns
shall not be held liable for any accidents, illness, injury or damage to property. Maize
Recreation Commission does not provide any medical insurance for accidents.
Parents/Guardians are responsible for insurance. Parents must sign for children, 18 and
under, entering program. Registration is not valid without signature.
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I have read the above release
& accept.
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Date:
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