2019 Baci Golf Junior Camp Registration

Child 1 Information and Medical Release

Child 1. Please select each week that will be attended *

Child 1 First Name *

Child 1 Last Name *

Child 1 Birth Date * +

Child 1 Gender *

Male

Female

Child 1 Doctor Name *

Child 1 Doctor Phone *

Does your child (Child 1) have any Allergies? *

No

Yes, Child 1 has Allergies. ALL ALLERGIES MUST be listed in the space provided. Yes, Child 1 has Allergies. ALL ALLERGIES MUST be listed in the space provided.

In the event my son/daughter has an allergic reaction to any/all of the above listed allergies, I hereby, give Baci Golf staff members full permission to use the EpiPen device, I the guardian, have provided.

In case of accident or illness, I request that Baci Golf attempt to contact me at the phone number(s) provided. If a parent cannot be reached, I hereby authorize Baci Golf to contact the physician listed above and if necessary, to transport my child to his/her physician, or to the nearest hospital.

*

I acknowledge I have completely read and have full understanding of the Allergy and Medical disclaimers above for Child 1.

Signature of Parent / Legal Guardian Child 1 *

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Child 2 Information and Medical Release

Child 2. Please select each week that will be attended *

Child 2 First Name

Child 2 Last Name

Child 2 Birth Date +

Child 2 Gender

Male

Female

Child 2 Doctor Name

Child 2 Doctor Phone

Does your child (Child 2) have any Allergies? *

No

Yes, Child 2 has Allergies. ALL ALLERGIES MUST be listed in the space provided. Yes, Child 2 has Allergies. ALL ALLERGIES MUST be listed in the space provided.

In the event my son/daughter has an allergic reaction to any/all of the above listed allergies, I hereby, give Baci Golf staff members full permission to use the EpiPen device, I the guardian, have provided.

In case of accident or illness, I request that Baci Golf attempt to contact me at the phone number(s) provided. If a parent cannot be reached, I hereby authorize Baci Golf to contact the physician listed above and if necessary, to transport my child to his/her physician, or to the nearest hospital.

I acknowledge I have completely read and have full understanding of the Allergy and Medical disclaimers above for Child 2.

Signature of Parent / Legal Guardian Child 2

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Child 3 Information and Medical Release

Child 3. Please select each week that will be attended *

Child 3 First Name

Child 3 Last Name

Child 3 Birth Date +

Child 3 Gender

Male

Female

Child 3 Doctor Name

Child 3 Doctor Phone

Does your child (Child 3) have any Allergies?

No

Yes, Child 3 has Allergies. ALL ALLERGIES MUST be listed in the space provided. Yes, Child 3 has Allergies. ALL ALLERGIES MUST be listed in the space provided.

In the event my son/daughter has an allergic reaction to any/all of the above listed allergies, I hereby, give Baci Golf staff members full permission to use the EpiPen device, I the guardian, have provided.

In case of accident or illness, I request that Baci Golf attempt to contact me at the phone number(s) provided. If a parent cannot be reached, I hereby authorize Baci Golf to contact the physician listed above and if necessary, to transport my child to his/her physician, or to the nearest hospital.

I acknowledge I have completely read and have full understanding of the Allergy and Medical disclaimers above for Child 3.

Signature of Parent / Legal Guardian Child 3

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Parent Information

Full Name of Parent / Legal Guardian *

Parent / Guardian Phone Number *

Email Address *

Address *

City *

State *

Zip Code *

In The Event Of An Emergency, Please List (2) Contact Names And Phone Numbers.

Emergency Contact 1 Full Name *

Emergency Contact 1 Phone Number *

Emergency Contact 2 Full Name *

Emergency Contact 2 Phone Number *

I give Baci Golf the right and permission to use, reuse, electronically reproduce, publish and republish photographs that may feature or include my son/daughter. I also grant permission to use my son's/daughter's name in connection with the camp if Baci Golf so chooses. I release and discharge Baci Golf from any and all claims arising out of/or in connection with the use of the photographs, including any and all claims for libel.

Liability Disclaimer - As the minor's parent/guardian, by registering or electronically submitting a player profile, application, or entry into a Baci Golf Event, I hereby consent to his/her participation in the Activity and the release below. I understand Baci Golf does not provide liability insurance for the protection of individuals, groups, organizations, businesses, spectators, or others who may participate in our tournaments. In consideration in said activity, the individual, group, organization, business, spectator, or other (collectively 'Participant') does hereby release and forever discharge Baci Golf and its affiliates and respective officers, directors, volunteers, agents, contractors, representatives, members, partners, boar members and employees (collectively, 'releases') jointly and severally from any/all actions, causes of actions, claims and demands for, upon or by reason of any damage, loss, death, or injury, which may hereafter may be sustained related to (II) My participation in the activity, (III) the negligence or other acts, whether directly or connected to these activities or not, caused by these release or (IV) or the condition of the premises where the activity occurs whether or not I am participating in the activity. I also agree that I, my assignees, heirs, executors, administrators, distributers, guardians, next of kin, spouse, legal representatives will not make a claim against, sue, or attach the property of any release in connection with the matters covered by the foregoing release. by digitally signing I acknowledge I have completely read and have full understanding.

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I acknowledge I have completely read and have full understanding of the above disclaimers.

Signature of Parent / Legal Guardian *

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