BRAD J. SMITH, PGA

www.golfdronline.com

 

2017 YOUTH SUMMER GOLF PROGRAMS

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            

 

Sibling 4 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:

 

                          Evening Youth Camp, June 5 to June 9, $175

 

                          Morning Youth Camp, June 12 to June 16, $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 2017 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

 

                                               

Date