494 Main Street, Manchester, CT, 06040, US
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Date of Birth
My child does not have a parent/guardian to participate, please provide them with an on-site mentor.
The child named above has permission to participate in all activities except as noted by myself.
Additionally, I the undersigned do hereby waiver and hold harmless the Town of Manchester, Manchester Country Club, its employees and agent, from any personal or property damage I or any child may incur while participating in this activity. I understand the Town of Manchester does not provide accident or health insurance. I also give permission to the Town of Manchester, Manchester Country Club, associated Town Departments, and local news media to take pictures of and/or film my child during golf activities. I understand that these entities may include these pictorial and/or film images of my child in their public service announcements, publications, or on their websites.