Hank Haney - Junior Camp Release Form

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:
____________________________________________________

Parent's Names:
____________________________________________________

Address:
____________________________________________________

City/State/Zip:
____________________________________________________

Home Phone:
____________________________________________________

Emergency Phone:
____________________________________________________

E-Mail Address:
____________________________________________________

Special Medical Conditions:
____________________________________________________

____________________________________________________

____________________________________________________

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.

____________________________________________________

Signature of Parent/Guardian

____________________________________________________

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