Name:
Age on June 1:
Address:
City, Zip:
Boy / Girl
Home Phone:
Other Phone:
Beeper:
Guardian Name:
Camp #:
Paid:
I, _______________________, the legal guardian of the child named
on this form, do grant permission to medical personnel to
administer medical attention to my child should it be required
during the two days of the junior golf camp. I have made note
below in regard to any special medical condition or allergies that
you should be aware of.
I also hold harmless Keeton Park, Kim J. Brown and staff,
Pause Golf, Inc. and the City of Dallas as I realize that safety
precautions have been taken and that the nature of group golf
instruction has some inherent danger of injury. Special
Conditions?_______
_______________________________________________________________________
Signed___________________________________ Date___________
Return to: Kim J. Brown, Keeton Jr Camps, PO Box 17458, Dallas, TX 75217
First paid 24 campers in each session !
Want to go, can't afford it? Call Kim about the Help a Kid Program !