SUMMER CAMP REGISTRATION FORM
I. CAMPER INFORMATION
First Name: Click here to enter text.
Last Name: Click here to enter text.
Gender: Click here to enter text.
Date of Birth (must be 5-12) : Click here to enter text.
T-shirt size (CS, CM, CL, AS, AM, AL): Click here to enter text.
II. PARENT/GUARDIAN INFORMATION
PARENT 1
First and Last Name: Click here to enter text.
Preferred Phone No.: Click here to enter text.
Alternate Phone No.: Click here to enter text.
Email: Click here to enter text.
PARENT 2
First and Last Name: Click here to enter text.
Preferred Phone No.: Click here to enter text.
Alternate Phone No.: Click here to enter text.
Email: Click here to enter text.
III. (OPTIONAL) DO YOU HAVE ANOTHER CAMPER?
First Name: Click here to enter text.
Last Name: Click here to enter text.
Gender: Click here to enter text.
Date of Birth (must be 5-12) : Click here to enter text.
T-shirt size (CS, CM, CL, AS, AM, AL): Click here to enter text.
IV. (OPTIONAL) DO YOU HAVE ANOTHER CAMPER?
First Name: Click here to enter text.
Last Name: Click here to enter text.
Gender: Click here to enter text.
Date of Birth (must be 5-12) : Click here to enter text.
T-shirt size (CS, CM, CL, AS, AM, AL): Click here to enter text.
V. EMERGENCY CONTACT
EMERGENCY CONTACT 1
First and Last Name: Click here to enter text.
Preferred Phone No.: Click here to enter text.
Alternate Phone No.: Click here to enter text.
EMERGENCY CONTACT 2
First and Last Name: Click here to enter text.
Preferred Phone No.: Click here to enter text.
Alternate Phone No.: Click here to enter text.
VI. ALL OTHER PERSON’S AUTHORIZED TO PICK UP YOUR CHILD(REN) FROM CAMP:
Name & Relationship: Click here to enter text.
Name & Relationship: Click here to enter text.
Name & Relationship: Click here to enter text.
Name & Relationship: Click here to enter text.
VII. MEDICAL
Listing your child’s name first, please tell us, in full, about any medical/health, and/or developmental or behavioral conditions,
including speech, occupational therapy, or the like, past or present, and any other pertinent information that might aid in the
enhancement of your child’s camp experience. Use a separate sheet as necessary. We strive to care for children with various needs, but
we need your full input to succeed.
Click here to enter text.
Listing your child’s name first, please list all allergies, current medication(s), vitamins, inhalers, etc. Please note that if your child
requires an emergency allergy kit (ie. Epipen, bee sting kit, or inhaler, etc), you must supply medication labeled with child’s name and
detailed instructions on our Permission to Administer Medication form to the summer camp office prior to your child’s attendance. Kits
are returned if unused.
Click here to enter text.
VIII. PERMISSION & LIABILITY WAIVER
My child(ren) has/have permission to fully participate in Greystone Golf & Country Club’s (GGCC) summer camp activities during the
2015 summer term. I, as parent/legal guardian, do hereby grant the GGCC staff and designated adults the right to authorize emergency
medical treatment for my child in the event that I or my designated representa-tive cannot be reached. I agree to hold harmless
Greystone Golf & Country Club and its agents from liability resulting from an accident. The Alabama Good Samaritan Law will apply.
I hereby grant permission for staff to take whatever steps may be necessary to obtain emergency treatment for my child. These steps
may include, but are not limited to, the following:
1. In a life-threatening emergency or urgent situation, staff will call 911 before making any attempt to contact parents.
2. For a non-life-threatening emergency, we will attempt to call the parent/guardian first, and if we cannot reach them, we will attempt
to contact the Emergency contacts listed on the Emergency Information form. If we cannot make an appropriate contact, we will call
para-medics or the child's health care provider.
I understand that GGCC and staff will not be responsible for anything that may happen as a result of false information provided by parents/guardians, or as a result of the parent/guardian’s failure to provide information at the time of enrollment. I understand that staff will
not administer drug or medication without specific written & signed instruction from the health care provider and/or the child's
parent/guardian.
Enrollment for your child in GGCC’s Summer Camp Program constitutes your agreement to this waiver.
Signature: Click here to enter text.
Date: Click here to enter text.
GREYSTONE GOLF & COUNTRY CLUB
REGISTRATION FORM
Camp will be held rain or shine
Pricing: $295 each week which includes an ice cream social on Sunday night before the 1st day of camp
Camp hours: 8:30am – 3:00pm
Cancellation policy: no charge for 7+ days notice / half charge for 6 or less days notice
List Name(s) of Child(ren) who will attend:
Click here to enter text.
List the week(s) each child will attend (Choices are June 13-17, June 27-July 1, July 25-29, and August 1-5):
Click here to enter text.
PAYMENT METHOD: Member Number or Credit Card
If you are a member and would like to put the charges on your Member Number, please type your Member # here:
Click here to enter text.
To pay by credit card, please complete the credit authorization form below and return with the registration form.
Be sure to save this document once you have completed the required fields.
Return registration form to Sarah May at [email protected] or fax to (205) 980-5202
4100 Greystone Drive, Birmingham, AL 35242
CREDIT CARD AUTHORIZATION
Cards we accept: Visa, Master Card, American Express and debit cards.
CREDIT CARD INFORMATION
Name on the card: Click here to enter text.
Billing Address: Click here to enter text.
City, State and Zip: Click here to enter text.
Card Type: Click here to enter text.
Card Number: Click here to enter text.
Expiration Date: Click here to enter text.
Security/Verification Code: Click here to enter text.
I authorize Greystone Golf & Country Club to charge the above referenced card for the camp week(s) that I
identified on the above registration form.
Signature: Click here to enter text.
Date: Click here to enter text.