Junior Golf Contact Form
Sign in to Google to save your progress. Learn more
Participant(s) Name *
Participant(s) Address (Street Address , City, Zip Code) *
Parent/Guardian 1 Name *
Parent/Guardian 1 Relation *
Parent/Guardian 1 Email (for updates, rain days, other important information) *
Parent/Guardian 1 Phone *
Parent/Guardian 2 Name *
Parent/Guardian 2 Relation *
Parent/Guardian 2 Email (for updates, rain days, other important information) *
Parent/Guardian 2 Phone *
Emergency Contact 1 *
Emergency Contact 1 Relation *
Emergency Contact 1 Phone *
Emergency Contact 2 Name *
Emergency Contact 2 Relation *
Emergency Contact 2 Phone *
Please list any medical issues the participant may have (i.e. asthma, allergies, etc.)
Waiver
Medical Release
I fully realize that injury or illness to my child(ren) may result from or during participation in junior golf camp. In case of injury or illness, I give permission for my child to be given medical treatment as deemed appropriate. I further give permission for the information provided on this form to be shared with appropriate medical personnel. I consent and authorize Old Hickory camp representatives to sign on my behalf the Notice of Private Practice that patients are required to receive in accordance with federal law. I understand and acknowledge that I will be responsible for any medical bills incurred by my child.
Liability
For good and valuable consideration, including, but not limited to my minor child being permitted to participate in Junior Golf Camp and related activities (the “program”), I, my successors, heirs, assigns, executors, administrators, spouse, and next of kin, agree as follows:
Parent/Guardian Authorization
I fully understand that my child(ren)’s participation in athletic activities, by nature, involves a risk of serious injury or death, including economic losses, which may result not only from my child(ren)’s actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the Program is being conducted, the rules of play, or this type of Program.
I acknowledge that I fully realize the dangers of participating in such activities, and fully assume all risks associated with my child(ren)’s participation in such activities, including, without limitation, any and all risks of bodily injury to my child, including medical or hospital bills, permanent or partial disability, death, and damages to my property, caused by or arising from my child(ren)’s participation in the Program.
I covenant not to sue or present any claim for personal injury, property damage, or wrongful death against Old Hickory Golf Club, or their affiliates, or such parties’ respective officers, directors, trustees, employees, agents or representatives (including, without limitation, coaches) (collectively, the “Released Parties”), for any loss of or damage to property, injury, or death suffered or incurred by any person while participating in, observing or otherwise being involved in the Program.
I hereby release, waive, discharge, and relinquish the Released Parties from any liability, loss, damage, claim, demand or cause of action of any and all kinds, nature and character whatsoever, known or unknown, including, but not limited to, any liability, loss, damage, claim, demand or cause of action arising out of or in connection with the Released Parties’ negligence in connection with my child(ren)’s participation in the Program.
I am giving the Released Parties a general release of any and all claims, present and future, that I and my child(ren) may have against the Released Parties. I understand that the granting of the foregoing release and covenant not to sue is an express condition to my child being permitted to attend and participate in the Program.
I verify that my child has been checked by a licensed physician prior to attending the Program and that my child is in good health and has no physical condition that would prevent him/her from participating fully in any event. I understand that if there is any change in my child(ren)’s health or personal information, it is my responsibility to promptly inform the staff at Old Hickory Golf Club of the change.
I acknowledge and agree that in accordance with my child(ren)’s participation in the Program, photographs, pictures, slides, movies, or videos of my child(ren) may be taken without compensation from Old Hickory Golf Club, and I consent, in perpetuity, to the use of these photographs, pictures, slides, movies, or videos for any legal purpose.
In addition, if the undersigned, their heirs, assigns, executor, administrator, spouse, or next of kin, fail to comply with any of the provisions of the Agreement and Old Hickory Golf Club, take action to enforce this document, the undersigned, their heirs, assigns, executor, administrator, spouse and next of kin will pay the reasonable costs and expenses, including attorney’s fees incurred in preparation for or participating in any arbitration or litigation in connection with the enforcement of this document, as determined by the court or arbitrator. All lawsuits under this Consent Agreement and Waiver, unless otherwise specified, shall be filed in Dodge County, Wisconsin.

Junior Golf Camp Rules and Guidelines
As a condition of participating in the Program, both my child(ren) and I agree to abide by the following rules and guidelines. I fully understand and acknowledge that any Student, including my child(ren) in violation of the Rules and Guidelines will be sent home immediately without refund. The Rules and Guidelines are as follows:
All students are expected to maintain a positive attitude throughout the camp.
Bad language and club throwing will not be tolerated.
Absolutely NO drugs, alcohol or tobacco will be allowed at any time.
All Students will be supervised by a staff member and Students must notify the staff if they need to deviate from the schedule for any reason.
For medical purposes each Students’ medical insurance and health information is required at registration.

THIS DOCUMENT RELIEVES OLD HICKORY GOLF CLUB AND OTHERS FROM LIABILITY FOR BODILY INJURY, WRONGFUL DEATH, AND PROPERTY DAMAGE BY NEGLIGENCE. I HAVE READ THIS DOCUMENT, UNDERSTAND THAT I GIVE UP SUBSTATIAL RIGHTS AND ASSUME ALL RISK BY SIGNING IT AS THE PARENT/GUARDIAN OF THIS CHILD(REN), AND SIGN VOLUNTARILY.



The information requested on this form is confidential and for emergency use only. In the event of an emergency while participating in Junior Golf, the information will be used by Old Hickory Golf Club personnel. Please provide accurate, complete and true information.


Waiver Acknowledgement *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of THE GOLF CHANNEL. Report Abuse