PLEASE FILL OUT THE REGISTRATION FORM & PARENTAL AGREEMENT

We look forward to having you and your “Kids” be a part of “The Lutz Executive Golf Center”

I, the parent/guardian of the golf camp program(s) herby give approval for his/her participation in any and all activities during the “Kids in Golf” Summer Camp.  I assume all risks and hazards incidental to such participation including transportation to and from the activities and agree to hold harmless “The Lutz Executive Golf Center”, and organizers, teaching professionals and participants.  I also authorize program organizers to contact emergency medical service to perform first response medical treatment in the event my child/ward shall be injured while participating in this activity.  I also understand that my child/ward is not covered by accident insurance through any of the aforementioned parties and I am responsible for any such occurrences.

Parent/Guardian Signature ______________________________________ Date: ______/______/2006

Printed Name_________________________________________________________________________

Signed by Fax  or Email - Please Check Box

Registration Form

Name _____________________________________   Age ________     Birthday__________________

EMAIL ___________________________________________       Deposit Received ________________

Parent/Guardian    _____________________________________________________________________

Phone #’s ___________________________________________________________________________

Emergency Contact(s) ________________________________________________________________

Fees are refundable with 48 hour notification.
Miss Beth, Certified Golf Educator with the National Golf Foundation
Gary Burdick, Touring Professional for The Lutz Executive Golf Center

Print form and mail the COMPLETED form (or drop it by The Center) with all fees to:
The Lutz Executive Golf Center
2220 Newberger Rd
Lutz, FL 33549
OR register in the Pro Shop