2019 Waverly Woods Jr Camp Registration
Camper's information
First Name *
Your answer
Last Name *
Your answer
Name of Person Submitting Online Store Payment *
Your answer
Gender *
D.O.B *
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Age at Time of Camp *
Your answer
Are you a returning camper? *
Will your child be using their own set of clubs? *
Right or Left Handed? *
What height category does your child fall into? (Club Rentals) *
SESSION DATES AND SKILL LEVELS
Half Day camps will run from 9:00AM to 12:30PM.
Full Day camps will run from 9:00AM to 3:00PM.
All camps INCLUDE lunch from the Waverly Woods Grill.
Available Sessions
Beg. 1/2 Day
Beg. FULL Day
Inter. 1/2 Day
Inter. FULL Day
Week 1: June 24 - June 28
** No Camp ** Week of July 4th
Week 2: July 8 - July 12
Week 3: July 15 - July 19
Week 4: July 22 -July 26
Week 5: July 29 - Aug 2
Week 6: Aug 5 - Aug 9
Week 7: Aug 12 - Aug 16
Friends to be grouped with (we'll do our best)
Your answer
How did you hear about Waverly Woods Golf Camp? *
Required
If referred by a friend who referred you (First & Last Name)
Your answer
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
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
Authorization to Treat Waiver
I request and authorize Waverly Woods 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 Waverly Woods 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. *
Required
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 Waverly Woods in order to be processed.
I agree to the Refund Policy. *
Required
General Matters
I agree that Waverly Woods 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 Waverly Woods 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 Waverly Woods Golf Course are the sole and exclusive property of Waverly Woods Golf Course and may be used by Waverly Woods for promotional purposes.
I agree to the General Matters Policy. *
Required
Informed Consent Wavier
In exchange for Waverly Woods permitting my child to participate in Waverly Woods Golf Camp, I agree to the terms and conditions expressed herein. While Waverly Woods 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 Waverly Woods, 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. *
Required
I enter my name below to verify that all submitted information is correct and that I understand and agree to all waivers and policies. *
Your answer
Date:
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Use This Space for Special Notes and Promotions
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