Held at Heatherwoode Golf Club,


 Springboro, Ohio

REGISTRATION FORM – Pre-Registration is Required


Please Print


Child 1 First Name                                                         Last Name                                                  


Female /Male                 Left / Right Handed               Birth Date                                Age            


Sibling 2 First Name                                                      Last Name                                                  


Female /Male                  Left / Right Handed               Birth Date                                Age            


Sibling 3 First Name                                                      Last Name                                                  


Female /Male                  Left / Right Handed               Birth Date                                Age            


Parent/Guardian Name                                                                                  


Home Phone                               Work Phone                                         Cell Phone                             


Student’s Address                                                                                                                  


City                                                                     Zip Code                            


E-Mail Address                                                                                              


Emergency Contact                                                        Phone Number                                                


Please Check Program(s) for which You are Registering:



                          Youth Camp 3, June 17 to June 21, 8:30 am to 10:30 am, $175


                          Youth Camp 4, June 17 to June 21, 7:00 pm to 9:00 pm, $175


Cash or Check only. 

Make checks payable to The Golf Doctor

Mail Checks & Registration Form to:

220 Bayberry Drive

Springboro, OH 45066

Or drop off cash or check, with registration form to Heatherwoode Golf Club Pro Shop


Method of Payment (please check)  Cash                  Check                   Total Amount Paid    


I, parent/guardian of the above named person(s), hereby give my consent to participate in any and all of the activities of the 2019 Summer Youth Golf Programs.  I assume all risks and hazards incidental to the conduct of activities and transportation to and from activities.  I do further hereby resolve, absolve, indemnify, and hold harmless, Brad Smith, The Golf Doctor, camp instructors, Heatherwoode Golf Club, and the city of Springboro.



Signature of Parent/Guardian                                     Printed Name of Parent/Guardian