Facility to Attend *

• Vista Ridge
• Westridge
• Dallas Market Center (Opening Spring 2010)
• Texarkana Golf Ranch

Desired Camp Date *

-- Please Select --Spring Break Camp: March 15-18 June 7-10 June 14-17 June 21-24 June 28-July 1 July 5-8 July 12-15 July 19-22 July 26-29 August 2-5 August 9-12 August 16-19

Child's Name *

Child's Date of Birth *

Gender *

• Boy
• Girl

Parent/Guardian's Name *

Address *

Home Phone Number *

Emergency Phone Number *

Please list below any medical conditions that we should be aware of, including medications. Please also list any foods or medications that your child is allergic to: *

I, understand, as Parent/Guardian of the above named minor do hereby release the Hank Haney Golf Facility and instructors from any and all liability from any accidents which may occur while my child is at golf camp. I also authorize any medical assistance *

• I have read and agree to the terms

* Required Fields