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Town of Manchester, CT

info@manchesterct.gov

494 Main Street, Manchester, CT, 06040, US

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APPLICATION FORM

We have reached our max number of particpants. If you would like to be on the waitlist please continue to fill out this form.

Child Participant Information

Full Name

Full Address

Date of Birth

Date Picker

Parent/Guardian Information

My child does not have a parent/guardian to participate, please provide them with an on-site mentor.

Full Name

Full Address

Date of Birth

Emergency Contact Information

Parent/Guardian Authorization (REQUIRED FOR ALL PERSONS UNDER 18)

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.

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