Joe Caggiano Golf School Parent/Child Registration

NAME:

PARENT NAME:

STATE:

ZIP CODE:

HOME PHONE:

CELL PHONE:

EMAIL:

EMERGENCY CONTACT:

PHONE:

MALE:

FEMALE:

SELECT DATE:

AGE:

ADDRESS:

CITY:

Assumption of Risk – As the parent or guardian of the above named minor or dependant, I assume full responsibility for the decision for my child/dependent to
participate in Jr. Golf programs and tournaments (the “programs”) of Springfield Golf Center. I acknowledge that participation by my dependent in the activities listed
above may entail known and unanticipated risks, which could result in physical injury, death or property damage. I understand that such risks cannot be eliminated
without jeopardizing the essential qualities of the activity. The risks may also occur as a result of my dependant’s own actions, inactions or negligence, as well as
actions, inactions or negligence of others, weather conditions, condition of equipment, condition of the facilities and grounds, natural disaster, national disaster, and
any first aid emergency treatment which may be administered. There may also be other risks that are not foreseeable at this time. 2. Release – As part of the
consideration for my dependant participating in the activity identified above, I release, discharge, and hold harmless Springfield Golf Center, any director, officer,
employee, or any person acting in any capacity on their behalf (hereinafter collectively referred to as “SGC”) from all demands, causes of action, suits, contracts,
agreements, obligations, covenants, defenses, costs, liabilities and judgments, whatsoever, known or unknown, suspected or unsuspected, in contract or in tort, in
law or in equity, which I might have against the SGC, arising from my child/dependent’s participation in the Programs. 3. Waiver and Indemnification – I herby waive
all claims and demands against SGC for any loss, damage, injury (including death) or claim of any kind arising from, related to or caused by my dependent’s
participation in the Programs and agree to indemnify, defend, and hold harmless SGC from all loss, liability, damages, costs, and expenses (including actual attorney’s
fees) arising from or related to same. 4. Photography/Video – In permitting my dependent to participate, I understand that my dependent’s photograph/video may
appear in publicity or brochures marketing SGC programs and facilities. I understand that there are not rights granted to me or my dependents to inspect or approve
photographs/video prior to publication. 5. Term- I have read this Agreement and agree to be bound by its terms. This Agreement shall be effective for all golf
activities in which my dependent participates throughout the entire 2011 calendar year. I freely execute this document.

I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS OF RISK AGREEMENT:

I UNDERSTAND BY CHECKING THIS BOX I AM ELECTRONICALLY SIGNING THIS CONTRACT: