12-hr. Scrapbook Crop: July 12, 2025 Resident Registration Form Participant Name(Required) AgeDate of Birth Parent/Guardian Name (if participant is under 18)Telephone Number(Required)Email(Required) Under the Americans with Disabilities Act, does participant require accommodations to participate in this activity?Please SelectYesNoComment#2025-0712: 12-hr. Scrapbook Crop: July 12, 2025 - Resident Price: Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Waiver Review & Agreement Read the Program Waiver (PDF)Waiver Agreement(Required)I have read and understand the WAIVER, RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT FOR GRANDWOOD PARK PARK DISTRICT. I understand that by checking this box and entering my name in the box below I am agreeing to all of the terms of that waiver, release of all claims and hold harmless agreement. I agree Name of Participant (18+) or Parent/Guardian(Required) Please note: Registrations received without the box checked and/or without the name of participant/guardian in the space provided will be denied.CAPTCHACheck the box below to help us stop spam.
