Please print and complete this form prior to attending any of the Day Camps. Fax the completed form to the location your child will be attending Camp or have your child bring it with him/her on the Hank day of Camp.
Child's Name:
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Parent's Names:
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Address:
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City/State/Zip:
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Home Phone:
____________________________________________________
Emergency Phone:
____________________________________________________
E-Mail Address:
____________________________________________________
Special Medical Conditions:
____________________________________________________
____________________________________________________
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I, the undersigned, as Parent/Guardian of the above named minor do hereby release the Hank Haney Golf Facility, its employees and instructors, from any and all liability from any accidents which may occur while my child is at golf camp. I also authorize any medical assistance that may be required for the above named child during my absence.
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Signature of Parent/Guardian
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Date
