Participant Permission Form

Select Session:June 20-August 1 - 6 Week Camp - 9:00-10:00amJune 25 - August 1 - 5 week Camp - 11:00am-12:00pmJune 25 - August 1 - 5 week Camp - 12:00pm-1:00pmJune 25 - August 1 - 5 week Camp - 1:00pm-2:00pmJuly 15-18 - 4 Day Camp - 12:00pm-4:00pm
Participant’s First Name:
Participant’s Last Name:
Gender: MaleFemale
Birth Date:
Shirt Size:
Height:
Address:
City:
State:
Zip Code:
Parent/Guardian:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Parent Email:
Other/Emergency Contact:
Home Phone Number:
Cell Phone Number:
Work Phone Number:

Does your child have any allergies or medical conditions we should be aware of?

I grant my child permission to participate in Milwaukee Area Youth Golf Academy’s sponsored program.I understand and assume the risk and danger incidental with the game of golf, including but not limited to, the risk of my child being hit by an errant or misdirected golf shot, and I agree to hold harmless Milwaukee Area Youth Golf Academy, participating agencies, the participating facility and the employees thereof from any and all liabilities resulting from such causes.

YesNo

I hereby give Milwaukee Area Youth Golf Academy and participating agencies permission to videotape, film and/or photograph my child and the right, in perpetuity, to use my child’s name, likeness, biographical information and voice in all forms of media (including the internet) in connection with the advertising and promotion of Milwaukee Area Youth Golf Academy.

YesNo

I understand that any golf equipment received for use is the property of Milwaukee Area Youth Golf Academy and is to be returned upon the completion of the participant’s involvement with the program.

In the event that I or the designated emergency contact cannot be reached in an emergency, I agree to accept any and all determinations of need for medical assistance and/or administration of medical attention deemed necessary by the Milwaukee Area Youth Golf Academy representatives. I hereby give permission of selected medical personnel to secure any and all medical treatment necessary. In event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the parent or guardian.

Is your family enrolled in Supplemental Nutrition Assistance Program (S.N.A.P.)?

YesNo
Do you qualify for the National School Lunch and/or School Breakfast Program?
YesNo

Session Attending: Tee Level (Beginner)Green Level (Continuing)

Golf Experience: NoneSomePlays

Right or Left Handed:RightLeft

Digital Signature (type full name):