If Applicable: Additional Fees: $
Late Fee: $
Birth Certificate On File:
Shirt Size (Adult/Youth; Sm., Med., Lg., XL):
WAIVER FOR PARTICIPANTS (Required)
In consideration of your accepting this entry, I hereby, for myself, my child, my heirs, executors and
administrators, waive and release any and all rights and claims for damages I or my child may have against
the Wellington Recreation Commission, City of Wellington or USD 353 and its representatives, successors,
and assigns for any and all injuries suffered by myself or my child at any activities sponsored by these groups.
I acknowledge that a Parent or Legal Guardian must sign for any child, under the age of 18, entering the
program. ALSO, the undersigned waives any and all claims that he/she or his/her heirs, executors,
administrators, or assigns may have or claim to have resulting from a photograph, video, or reproductions
thereof of said persons while participating in WRC programs.
*Thank you for enrolling in this WRC program! We look forward to assisting you!
If you have any questions, please feel free to contact us at 620-326-3323.
Please feel free to PRINT THIS FORM! Fill it out, include the appropriate payment, and return it to the
WRC. For your convenience, we have several options for returning this form. Please see below.
Postal Service: Mail the completed form, along with the appropriate payment, to the WRC
at 202 S. Jefferson; Wellington, KS; 67152
Drop Off: Bring in your completed form, along with the appropriate payment