Southwestern Golf Camp Registration

Southwestern Golf Camp Registration
Camper Information
Camper Name*

First NameLast Name
Male or Female*
Current Grade in School*
Parent/Guardian Information
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Phone*
Please enter a valid phone number.
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Phone
Please enter a valid phone number.
Parental Consent
IN CONSIDERATION of being permitted to participate in any way in the Southwestern Community College (EVENT NAME) GOLF CAMP HELD AT 612 New York Ave, Creston, IA (“the Event”), EACH OF THE UNDERSIGNED hereby agrees, on behalf of myself and/or my child (if applicable):

1.The Activities associated with the Event may be dangerous and involve the risk of serious injury and/or death and/or property damage. I (and/or my child) can safely meet the physical and mental demands of the activity.

2.To release, waive, discharge, and covenant not to sue Southwestern Community College, its officers, board members, employees or agents (“Released Parties”) for any and all loss or damage, and any claim or demands therefor on account of any injury to persons or property or death arising out of or related to the Event, whether caused by the negligence of the Released Parties or otherwise.

3.To assume full responsibility for any risk of bodily injury, death or property damage arising out of or related to the Event whether caused by the negligence of Released Parties or otherwise, including the costs of any medical attention provided to me (and/or my child).

4.To indemnify and save and hold harmless the Released Parties and each of them from any loss, liability, damage, or cost they may incur arising out of or related to my (and/or my child’s) participation in the Event, whether caused by the negligence of the Released Parties or otherwise.

5.That this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Released Parties and is intended to be as broad and inclusive as is permitted by the laws of the State in which the Event is conducted and that if any portion there is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. I FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME, AND I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABLITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Dates Registering For ($25 per date - Cash/Check):

February 19th (5:30 - 6:30 pm)February 26th (5:30 - 6:30 pm)March 5th (5:30 - 6:30 pm)All Three Dates (Total of $50 for multiple dates)
Parent/Guardian Signature*

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Today's Date*

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Date
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Southwestern Golf Camp Registration

Camper Information

Parent/Guardian Information

Parental Consent