Golf- Registration Form

PLEASE PRINT THE FOLLOWING INFORMATION
                 
Name of Camper: _____________________________________________Age:_________________
Parent(S) or Guardian(s): ___________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Address: __________________________________________________________________________
City, State, Zip Code: _______________________________________________________________
Home Phone: (___)_____________________________Business Phone:(___)_________________
Emergency Number(s): (___)_______________________________Cell: (___)_________________
                 
      ** In case of emergency, I give permission to the camp administrators to authorize 
the necessary medical attention recommended by physicians or hospital staff.  
                 
____________________________________   ____________________________________
(Print Parent(s)/Guardian(s) name)   (Parent(s)/Guardian(s) signature)
 Email Address:  _____________________              
Has this athlete ever been medically advised not to participate in any sports?  
__________________________________________________________________________________
                 
Do you have any worries about the camper’s health or think there may be reason why the 
camper should not participate in the camps?        
__________________________________________________________________________________
                 
                 
I will assume all responsibility for injuries that my child may sustain during Camp.  
I hereby authorize the staff of the Howell PAL Camp to act for me according to their best
judgement in any emergency situation requiring medical attention and hereby release
the Staff and the Howell PAL harmless of any injuries or illnesses my child may have   
while attending the Camps.            
____________________________________   ____________________________________
Parent(s)/Guardian(s) Signature   Date
Within the last year – Please answer Yes or No.      
Sprains   If yes, where?   Height    
Fractures   If yes, where?   Left/Right handed  
Dislocations   If yes, where?        
Concussions   If yes, where?        
Vascular/Nerve Conditions            
               
Other health conditions – Please answer YES or NO.      
Diabetes   Mononucleosis   Heart Condition  
Epilepsy   Asthma     Heat Related Conditions
Lyme Disease              
Other Conditions Medical Staff Should be aware of       
               
Allergies – Please answer YES or No.          
Hay Fever     Food Peniclilin       
Insect Stings     Other      
Medication(s) camper will be taking at camp:      
Parent/Guardian            
Signature              
               
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TEAR OFF              
GENERAL INFORMATION  Beginners 7/26/10 -7/30/10 – Advanced 8/2/10-8/6/10
1.  Arrive on time and promptly be picked up at 12:00 p.m.    
2.  Campers should wear suitable clothing, hat, sneakers. 
3.  Campers should bring water bottles with names on bottles.    
4. Bring your own clubs if prefer          
Send application and payment to: Howell PAL          
    PO Box 713          
    450 Adelphia Road      
     Howell, NJ 07731