2019 Blue Mash Junior Camp Registration
Please fill out 1 form per camper. Please complete payment after submitting registration form. Call 301-670-1966 if you have questions or need assistance.
Camper's information
First Name *
Your answer
Last Name *
Your answer
Gender *
D.O.B *
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Age at Time of Camp *
Grade in September 2019
Your answer
Are you a returning camper? *
Does camper have his or her own clubs? *
Right or Left Handed? *
Friends to be grouped with (we'll do our best)
Your answer
Shirt Size *
How did you hear about Blue Mash Golf Camp?
FAMILY INFORMATION
Parent / Guardian Name *
Your answer
Street Address 1 *
Your answer
Street Address 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Work Phone
Your answer
Home Phone
Your answer
SESSION DATES AND SKILL LEVELS
Beginner sessions run Monday - Thursday from 9AM - 12:30PM
Intermediate/Advanced sessions run Monday - Friday from 9AM to 3PM
All sessions INCLUDE lunch from the Blue Mash Bar & Grill.
Camp Sessions
Beginner Half Day
Beginner Full Day
Intermediate
Beginner 5th Day Addition
(De-select)
Week 1 June 17th
Week 2 June 24th
Week 3 July 8th
Week 4 July 15th
Week 5 July 22rd
Week 6 July 29th
Week 7 August 5th
Week 8 August 12th
Week 9 August 19th
MEDICAL INFORMATION & PERMISSION TO TREAT
Immunization Information
A copy of an immunization record is required for campers/students who attend a school outside of the State of Maryland or who have not yet been enrolled in a Maryland School. If immunizations are contraindicated, a written statement must be provided.
Date of most recent tetanus (or DPT) immunization *
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Primary Care Physician *
Your answer
Primary Care Physician Phone Number *
Your answer
Pertinent information on any health conditions including physical, psychiatric, or behavioral:
Your answer
Please list any known allergies:
Your answer
Will prescription medication need to be administered to your camper during camp hours? *
EMERGENCY CONTACT INFORMATION
Emergency Contact (When Parent/Guardian is unavailable): *
Your answer
Emergency Contact Relationship: *
Your answer
Cell Phone: *
Your answer
Work Phone
Your answer
Home Phone
Your answer
Referred by
Your answer
Authorization to Treat Waiver
I request and authorize Blue Mash Golf Camp's staff to administer first aid and/or take my child to a physician or hospital for emergency treatment in the event it appears necessary and a parent or guardian cannot be contacted in a timely manner, as Blue Mash deems appropriate under the circumstances. I give to any physician, dentist, hospital, or other health care provider consent to perform any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment, under the supervision of any licensed physician or dentist. I agree that I will be financially responsible for the costs of such treatment and transportation.
I agree to the Authorization to Treat Waiver. *
Informed Consent Waiver
In exchange for Blue Mash permitting my child to participate in Blue Mash Golf Camp, I agree to the terms and conditions expressed herein. While Blue Mash will make every reasonable effort to keep all students safe from injury, illness, and harm, accidents do happen. I understand that there may be risks associated with the camp, and have had an opportunity to ask questions and to receive answers concerning those risks. I acknowledge that it is my responsibility to evaluate the risks associated with my child's participation in this camp to determine whether my child should participate, and to discuss these risks with my child. By signing this document, I agree to release and hold harmless Blue Mash, its officers, trustees, agents, employees, volunteers, and leaders/chaperones, and agree to indemnify each of them from any and all claims, costs, suits, actions, judgments, and expenses, upon any damage, loss or injury to my child or damage or loss to my child's property(including all property of others in my child's possession or control) arising out of my child's participation. These agreements of release and indemnity include claims of negligence, but not of gross negligence or intentionally wrongful conduct.
I agree to the Informed Consent Waiver *
Refund Policy
Refunds are available, minus a $50 cancellation fee, if enrollment is cancelled at least two weeks before camp. There will be no refund or pro-rated tuition for campers arriving late or leaving early in the session for which they are enrolled. All refund requests must be submitted in writing via e-mail and must receive written confirmation from Blue Mash in order to be processed.
I agree to the Refund Policy. *
General Matters
I agree that Blue Mash Golf Course is not responsible for the loss or damage to my child’s personal belongings as a result of fire, theft, laundry, gophers, etc. I agree to accept full responsibility, financial or otherwise, for the conduct of my child. In order to make each camper’s participation at Blue Mash Golf Course a fun, safe and rewarding experience, we hold high expectations for camper attitude and behavior. I understand that there is no refund should my child be dismissed from camp for behavior or conduct deemed unsatisfactory by the camp directors or if, in the sole opinion of the camp directors, a camper’s presence is not in the best interest of the camp. All pictures and videos taken at or in connection with Blue Mash Golf Course are the sole and exclusive property of Blue Mash Golf Course and may be used by
I agree to the General Matters policy. *
My typed name below verifies that all submitted information is correct and that I understand and agree to all waivers and policies. *
Your answer
I have completed this waiver on the following date:
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Use This Space for Special Notes and Promotions
Your answer
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