Parent Consent Form

To Whom It May Concern:

I, give my permission for the staff of the Red River Junior Golf, Inc. to seek medical attention for my child, if they feel that is necessary. I WILL NOT hold the golf course or any member of the Red River Junior Golf responsible for any injury to my child. Please list any medical condition your child has below.

Pre-existing Medical Conditions:_____________________________________________

Medical Release

We the parents of _______________________________, give our consent for emergency medical and surgical treatment of this minor in a licensed hospital, by a licensed physician, should their condition so require it in my absence. I understand that in such case, reasonable attempts would first be made to contact me, time and conditions permitting.

Parent/Guardian Signature___________________________________________________

Parent Name (please print)_________________________________ Date_____________

Emergency Contact:

Name:_______________________________ Relationship:_________________________

Phone: ______________________ ______________________ _____________________
                          Home                                  Work                                Cell

Address:_________________________________________________________________

Insurance Company:______________________________________________________

Policy Number:____________________________________________________________

Participant:_______________________________________ Age as of 8-1-08:__________

Address:_________________________________________ Grade going into:__________

City:_________________________ State:___________ Zip Code: _________________

Home Phone:_________________________ Work Phone:________________________

Gender:_____________ Date of Birth:__________________

Email:___________________________________________________________________

Parent's name (print):_______________________________________________________

Parent's Signature:_________________________________________________________