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3
2015 Student Registration and Waiver Form
Please mark the week(s) attending:
June 1- 4
June 22-25
June 8-11
June 29-July 2 __
June 15-18--Paid $169 by: Check/Cash _
Visa _
Master Card __
July 20-23
July 27-30
August 3-6 __
American
Express _
.Discover __
cc#/ expo date
Student First Name: __________________
Boy_ GirL Age
Student Last Name:
Birthday
_
Home Phone:
Mailing Address:
City
Zip
_
List any allergies:
_
School Atlending:
_
Grade:
_
Parent/Guardian 1 Name:
CeIlPhone:
_
Home/VVorkPhone:
_
EmaiiAddress:
_
Parent/Guardian 2 Name:
_
CeIlPhone:
VVorkPhone:
_
EmaiiAddress:
_
WAIVER RELEASE
This is to certify that I, as parentlguardian with legal responsibility for my minor child, acknowledge that my child will engaged in
activities that involve risk of injury at Leonard Golf Links and that I do recognize and assume risk, whether foreseeable or unforeseeable on behalf of my child in connection with participation in activities of recreation and instruction at Leonard Golf Links. On behalf
of my child and his/her legal representatives, I hereby release and agree to indemnify Leonard Golf Links, their affiliates, administrators, directors, agents, coaches, their employees, other participants, and sponsor agencies from any and all claims arising out of my
minor's involvement or participation in the programs at Leonard Golf Links.
Child's Name:
ParentlGuardian
_
Name:
ParentlGuardian
Date:
_
Signature:
_