Junior Golf Registration

Hog Neck Junior Golf Camp
2017 Registration Form
Ages 6 to 17

First Name*
Last Name*
eMail Address*
Home Phone No.*
WK Phone No.*
Mother Cell Phone No.
Father Cell Phone No.
Address
City
State
Zip Code
Date of Birth
Medical Concerns
Parent/Guardian
Permission for Photograph**
Gender*
Camp Dates and Times*
E-Signature***
* Indicates a required field.

**Occasionally, photographers will take photos of program participants for publication and/or use on our web site. Please check below if you have a preference for the above named participant regarding photos.  


***I acknowledge that I have complete understanding of the potential risk associated with this activity, including injury and death, and I voluntarily agree to assume all such risk. I hereby release, discharge, indemnify, and agree to told Talbot County, its officers, agents, and employees, harmless from and against any and all liability, claims actions, suits, damages, losses, or injuries of any kind, nature, or description, including without limitation personal injuries and/or death, medical expenses, and economic damages arising or claimed as a result of any act or omission related to the program(s) offered by the Talbot County Department of Parks and Recreation or any affiliated program.