Golf Camp Waiver & Release of Liability Authorization for Emergency Care

Disclaimer: Bella Vista Camp is not responsible for any I hereby authorize any physician, surgeon or dentist on the REGISTER NOW! injury or loss of property occurring as a result of playing, medical staff of the nearest medical facility in Arkansas, to practicing, participating in, or any other involvement a administer any emergency treatment, procedure or med- person may have in Bella Vista Golf Camp for any reason icine necessary or advisable for my child. I also authorize whatsoever, including negligence on the part of the Bella Bella Vista Golf Staff to secure the use of an ambulance, if Vista POA, its agents or employees. necessary, for transporting my child to the hospital. 2021 In consideration of my child’s participation, I hereby release ______the Bella Vista POA, Bella Vista Golf Camp, and any of their Signature of Parent/Guardian Date JR GOLF CAMP employees, instructors, and/or agents from any and all present and future claims resulting from negligence on My child has the following medical conditions or allergies of the part of the Bella Vista POA, Bella Vista Golf Camp, and which medical staff should be made aware: their employees, instructors, and/or agents for property damage, personal injury, or wrongful death, arising as a ______result of my child engaging in or receiving instruction in Bella Vista Golf Camp activities. I hereby voluntarily waive ______any and all claims resulting from negligence, both present and future, that may be made by my child, myself, or any In case of an emergency, please contact: other family member. NOTE: Your child will not be allowed to participate without this signed consent form. ______Name No. 1 Phone No.

______Signature of Parent/Guardian Date Name No. 2 Phone No.

______Witness Relationship Date Insurance Release

Check the appropriate box and complete information in Photo Release For Minor Child item 1, if applicable.

I hereby grant Bella Vista Property Owners Association o 1. This is to certify that my child is covered by the (hereinafter “BVPOA”) the absolute right and permission, following hospital insurance: with respect to any photographs taken in which my minor child appears, to use or publish the photos in any way, in ______any medium, and for any purpose (including promotion Name of Company Policy Number Highlands and advertising), and to use my minor child’s name in connection therewith. I hereby release and discharge And has my permission to participate in all Bella Vista Golf BVPOA from any claims arising from said use, including Camp sponsored activities. It is agreed that the Bella Vista claims for libel and invasion of privacy. Golf Camp Program and staff are released of all liability in the 9 a.m. - Noon I have read the foregoing and fully understand and agree event of injury. Two 4-day Camps Beginning: to the contents of this Release. o 2. This is to certify that we have No Insurance policy that will cover my child. However he/she has my permission to June 14 / July 12 participate in all Bella Vista Golf Camp sponsored activities. ______Minor Child’s Printed Name It is further agreed that the Golf Camp Program and staff are released of all liability in the event of injury.

______Signature of Parent/Guardian Date Signature of Parent/Guardian Date 2021Jr Golf Camp Registration Name of Juniors: Camp Fee: $125 per Junior

______Age: ______POA Member No. (if applicable) ______Age: ______Age: ______Name of Person Making Payment

The 2021 Bella Vista Junior Golf Camp is Name of Parents:______four days of intensive golf training taught Address (If same as Jr. Golfer, write same) by Bella Vista golf professionals and staff. Address:______The first three days of the Camp will be City: ______State:_____ Zip:______(______)______Home Phone No. held at the Highlands Driving Range, Home Phone No:______which provides a great golf instruction platform, with a putting green, chipping Cell Phone No.:______area, practice bunker and grass lesson . The last day will be held at Brittany Camp Dates: for golf, followed by a pizza party at the (Please check months attending) Method of Payment: Metfield Pool. o Check (payable to “Bella Vista POA”) o June 14, 16, 18, 19 o Cash o July 12, 14, 16, 17 CAMP INCLUDES o Credit Card • PGA Instruction from • Daily Games, Prizes CC No.:______Bella Vista Golf Staff • Course Management Mail registration form and payment to: • Etiquette and Rules • Play Days • Chipping, Pitching, • Parent-Child Event Exp. Date: ______/______CVV Code:______Putting (included with entry fee) • Full Swing • Pool Party Signature:______Instruction

Bella Vista POA For more information, Junior Golfers should bring Golf Division call (479) 855-5079 their own set of clubs each day. 98 Clubhouse Bella Vista, AR 72715 Visit us online: BellaVistaPOA.com