J
ug Bay Wetlands Sanctuary
Registration Form for Public Education Programs
Click here for a pdf version of the registration formThis form is not valid for scouts, schools, or other groups. Do not use this form for joining the Friends of Jug Bay. Use the Friends of Jug Bay membership form.
Most Public Programs do not have a program fee, although there is an entrance fee into the Sanctuary. For Canoe programs, Summer Camp, Home School Short Courses, or other programs with a program fee: Please print out and mail with the appropriate fee. Please make checks for programs payable to "Jug Bay Wetlands Sanctuary" and mail to 1361 Wrighton Road, Lothian, MD 20711. If you are paying for a program and joining the Friends at the same time, you must send separate checks (one for membership and one for program fees.) Membership checks may be mailed along with program registrations. For programs without a program fee, you may fax this form to 410-741-9346; or include all requested information and email to programs at jugbay.org. Please put "Jug Bay program registration" or similar subject line so that it does not get tagged as spam.
Child's name:
Birth date:
Child's name:
Birth date:
Child's name:
Birth date:
Street:
City, State, ZIP:
Home Phone:
Work Phone:
e mail:
Any health concerns or medications taken we should be aware of?
Any special needs or accommodations required?
Please provide us two weeks advance notice so we can make proper arrangements.
Program Title:
Program Date:
Program Fee:
Program Title:
Program Date:
Program Fee:
In case of emergency contact: Name
Relationship:
Home Phone:
Work Phone:
Photographs Taken of participants during programs may be reproduced in Jug Bay Wetlands Sanctuary publications.
In consideration of the Department of Recreation and Parks accepting me or my child(ren) in the program, I agree to release and discharge, Anne Arundel County, its employees and agents from any injuries sustained by my child or myself as a result of participation in the program. I agree to indemnify and hold harmless Anne Arundel County, its employees and agents against any liability incurred as a result of such injury or loss. It is understood and agreed that Anne Arundel County, its employees and agents cannot be responsible for any aggravation or injury caused as a result of a pre-existing disability; including but not limited to allergies. The Department of Recreation and Parks will be notified of any such disabilities or sensitivities in writing prior to enrolling in this program. I hereby give my permission for my child(ren) to attend all trips and activities sponsored by the Department of Recreation and Parks
Signature______________________________________________________________ Date___________________________
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