LOHREN'S GOLF CAMP REGISTRATION

Golfer's Name

First NameLast Name

Please select from the following.

Age

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child's/children participation in any and all activities prepared by Dr. Tammy Lohren, PGA Director of Instruction at Three Ridges Golf Course during golf camp/lessons/clinics/practices. As parent/guardian of the child/children named above, I understand all risks with my child/children attending the golf clinics/camps/lessons/practices held at Three Ridges Golf Course, The Barn Short Course at Beverly Park. I hereby release, absolve and hold harmless PGA Golf Professional, Dr. Tammy Lohren, assistant professionals, college players, Three Ridges Golf Course, The Barn Short Course at Beverly Park, all its respective officers, agents, and representatives of any and all liability from any accidents that may occur while my child/children are on the premises of Three Ridges Golf Course and/or The Barn Short Course at Beverly Park before, during, and after golf class. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Dr. Tammy Lohren, assistant professionals, college players, Three Ridges Golf Course, The Barn Short Course at Beverly Park, respective officers, agents, and representatives from any and all liability for injuries to my child/children arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to my child/children, I hereby waive all claims against Dr. Tammy Lohren, assistant professionals, college players, Three Ridges Golf Course, The Barn Short Course at Beverly Park, respective officers, agents, and representatives including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including golf. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

BEHAVIOR POLICY: Junior golfers violating proper rules and etiquette, may be removed from the class with no refund – no exceptions.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete above, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Dr. Tammy Lohren and affiliates, Assistant Professionals, college players including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

Media Release and Authorization: Pictures/videos will be taken during golf programs released on Facebook/Instagram/Website.

Payment

Full payment must be received no later than one week prior to start date.

Cash, Checks and Venmo (@Tammy-Lohren) paid in full one week prior to start date.

Please make checks payable to: Tammy Lohren

Mail to: 824 Commonwealth Ave., Strawberry Plains, TN 37871

Cell phone: 865-898-1836.

A $25.00 non-refundable deposit is required at registration with the balance paid in full August 7th. Refunds only available prior to the start of camp less the $25 deposit. Please submit a completed registration and waiver form along with your payment. Complete forms are necessary for each individual that attends Summer Jr. Golf Camp.

Cost: $300 Additional Siblings discounted: $275

Form of Payment

Lohren's Jr. Fall Ball Registration