Summer Golf Registration 2020 - Blue Mash
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Participant's information
First Name *
Last Name *
Name of Person Submitting Online Store Payment *
Gender *
D.O.B *
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Age at Time of Clinic *
Are you a returning participant? *
Will your child be using their own set of clubs? *
Right or Left Handed? *
What height category does your child fall into? (Club Rentals) *
SESSION DATES AND SKILL LEVELS
Available Sessions
Beg 1/2 Day
Beg Full Day
Inter 1/2 Day
Inter Full Day
Week 1: June 22 - June 26
** No Camp ** Week of July 4th
Week 2: July 6 - July 10
Week 3: July 13 - July 17
Week 4: July 20 -July 24
Week 5: FULL/CLOSED
Week 8: CLOSED - Inquire for Wait List
Friends to be grouped with (we'll do our best)
How did you hear about Blue Mash Golf Clinics? *
Required
If referred by a friend who referred you (First & Last Name)
FAMILY INFORMATION
Parent / Guardian Name *
Street Address 1 *
Street Address 2
City *
State *
Zip Code *
Cell Phone *
Email Address *
Work Phone
Home Phone
MEDICAL INFORMATION & PERMISSION TO TREAT
Immunization Information
A copy of an immunization record is required for students who attend a school outside of the State of Maryland or who have not yet been enrolled in a Maryland School. If immunizations are contraindicated, a written statement must be provided.
Date of most recent tetanus (or DPT) immunization *
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Primary Care Physician *
Primary Care Physician Phone Number *
Pertinent information on any health conditions including physical, psychiatric, or behavioral:
Please list any known allergies:
Will prescription medication need to be administered to your camper during clinic hours? *
EMERGENCY CONTACT INFORMATION
Emergency Contact (When Parent/Guardian is unavailable): *
Emergency Contact Relationship: *
Cell Phone: *
Work Phone
Home Phone
Authorization to Treat Waiver
I request and authorize Blue Mash Golf Clinic's staff to administer first aid and/or take my child to a physician or hospital for emergency treatment in the event it appears necessary and a parent or guardian cannot be contacted in a timely manner, as Blue Mash deems appropriate under the circumstances.  I give to any physician, dentist, hospital, or other health care provider consent to perform any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment, under the supervision of any licensed physician or dentist.  I agree that I will be financially responsible for the costs of such treatment and transportation.
I agree to the Authorization to Treat Waiver. *
Required
Refund Policy
Refunds are available, minus a $50 cancellation fee, if enrollment is cancelled at least two weeks before a clinic. There will be no refund or pro-rated tuition for participants arriving late or leaving early in the session for which they are enrolled. All refund requests must be submitted in writing via e-mail and must receive written confirmation from Blue Mash in order to be processed.
I agree to the Refund Policy. *
Required
General Matters
I agree that Blue Mash Golf Course is not responsible for the loss or damage to my child’s personal belongings as a result of fire, theft, laundry, gophers, etc. I agree to accept full responsibility, financial or otherwise, for the conduct of my child. In order to make each participant’s participation at Blue Mash Golf Course a fun, safe and rewarding experience, we hold high expectations for camper attitude and behavior. I understand that there is no refund should my child be dismissed from camp for behavior or conduct deemed unsatisfactory by the clinic directors or if, in the sole opinion of the clinic directors, a participant’s presence is not in the best interest of the camp. All pictures and videos taken at or in connection with Blue Mash Golf Course are the sole and exclusive property of Blue Golf Course and may be used by Blue Mash for promotional purposes.
I agree to the General Matters Policy. *
Required
Informed Consent Wavier
In exchange for Blue Mash permitting my child to participate in Blue Mash Golf Camp, I agree to the terms and conditions expressed herein.  While Blue Mash will make every reasonable effort to keep all students safe from injury, illness, and harm, accidents do happen.  I understand that there may be risks associated with the clinic, and have had an opportunity to ask questions and to receive answers concerning those risks.  I acknowledge that it is my responsibility to evaluate the risks associated with my child's participation in this camp to determine whether my child should participate, and to discuss these risks with my child.  By signing this document, I agree to release and hold harmless Blue Mash, its officers, trustees, agents, employees, volunteers, and leaders/chaperones, and agree to indemnify each of them from any and all claims, costs, suits, actions, judgments, and expenses, upon any damage, loss or injury to my child or damage or loss to my child's property(including all property of others in my child's possession or control) arising out of my child's participation.  These agreements of release and indemnity include claims of negligence, but not of gross negligence or intentionally wrongful conduct.
I agree to the Informed Consent Waiver. *
Required
I enter my name below to verify that all submitted information is correct and that I understand and agree to all waivers and policies. *
Date:
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Use This Space for Special Notes and Preferences, including whether you prefer morning or afternoon for the half day clinic
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