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Maize Recreation General Registration Form
Return to: MRC, P.O. Box 205, 10100 Grady Ave., Maize, KS 67101
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Name:
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Age & D.O.B.:
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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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Cell Phone:
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E-Mail Address:
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Parent/Guardian (if minor):
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Emergency Name &
Phone Numbers:
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Special Medical Information:
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Shirt Size (only if applicable):
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YS
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YM
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YL
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AS
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AM
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AL
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AXL
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AXXL
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Activity:
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Fee:
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Activity:
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Fee:
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Activity:
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Fee:
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Total Fee(s):
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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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Release: I acknowledge that by my signature below, the registrant listed above is
participating in the Maize Recreation Commission (MRC) programs at his/her own risk.
MRC, Maize USD 266, City of Maize, successors and assigns shall not be held liable for
any accidents, illness, injury or damage to property. MRC does not provide any medical
insurance for participants. Parents/Guardians are responsible for insurance. Parents
must sign for children, 18 and under, entering program. Registration not valid without
signature.
Model Release: The undersigned and participant authorize the Maize Recreation
Commission to use at its discretion any photograph(s) taken of the participant while
participating in any activity and waive any and all claims that the participant or the
undersigned or their heirs, executors, administrators, or assigns may have or claim to
have resulting from such photograph(s) or reproductions thereof.
Medical Release: In case of a medical emergency and I cannot be contacted; I give my
permission for a MRC representative to act in my place and to make medical decisions
concerning emergency treatment for the participant. I understand that the MRC staff is
not allowed to administer any medications.
Conduct: The undersigned and participant agree to abide by all the policies and guidelines
set forth by the MRC regarding this program and violations could result in being expelled
from the activity with no refund.
I, the undersigned, have read this release and understand all its terms. I execute it
voluntarily and with full knowledge of its significance.
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I have read the above release
& accept.
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Date:
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