Swing & Swim Sign Up Form

SWING & SWIM JUNIOR CAMP

AT ASHLEY PLANTATION COUNTRY CLUB

CAMPER INFORMATION:

CAMPER #1 CAMP DATES: PRICE:

FIRST NAME

FOOD ALLERGIES:

MEDICAL CONCERNS:

GOLF EXPERIENCE: NONE SOME LOTS

NEED CLUBS?

LAST NAME

CHOOSE ONE M F AGE/DOB

SWIMMING EXPERIENCE: NONE SOME LOTS

LEFT-HANDED IF YES, PLEASE CIRCLE ONE: NO YES

FIRST NAME CAMPER #2

FOOD ALLERGIES:

MEDICAL CONCERNS:

GOLF EXPERIENCE: NONE SOME LOTS

NEED CLUBS?

LAST NAME

RIGHT-HANDED

CHOOSE ONE M F AGE/DOB

SWIMMING EXPERIENCE: NONE SOME LOTS

LEFT-HANDED IF YES, PLEASE CIRCLE ONE: NO YES

FIRST NAME CAMPER #3

FOOD ALLERGIES:

MEDICAL CONCERNS:

GOLF EXPERIENCE: NONE SOME LOTS

NEED CLUBS?

LAST NAME

RIGHT-HANDED

CHOOSE ONE M F AGE/DOB

SWIMMING EXPERIENCE: NONE SOME LOTS

LEFT-HANDED IF YES, PLEASE CIRCLE ONE: NO YES

RIGHT-HANDED

PLANTATION

EMERGENCY CONTACT INFORMATION:

PICKUP INFORMATION:

PICKUP IS 3PM FROM THE POOL — AFTER-CAMP CARE IS AVAILABLE UNTIL 5:30PM

AT PICKUP

FULL NAME CLUB MEMBER? Y N PAYMENT: CHECK

ON CARD

CARD NUMBER EXP. / /

STREET ADDRESS CITY STATE ZIP EMAIL ADDRESS PHONE #

NAME

IF PAYING BY CREDIT CARD:

PARENT/GUARDIAN CONTACT:

NAME RELATION PHONE #

NAME PHONE # INITIAL

NAME RELATION PHONE # CREDIT CARD CHARGE MY CLUB ACCOUNT MAKE PAYABLE TO “ASHLEY PLANTATION CC” TUESDAY NAME PHONE # INITIAL

PICKUP WEDNESDAY NAME PHONE # INITIAL

PICKUP THURSDAY NAME PHONE # INITIAL AT PICKUP FRIDAY NAME PHONE # INITIAL AT PICKUP

MONDAY

AT

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