Pirate Camp 2012 Registration Form

Registration starts Sunday,  April 1st at 7AM

Please circle one:

Camp #1:  June 12th - June 16th   4 days and  one night      $ 350 per child

Camp #2:  July 17th   - July 21st     4 days and  one night      $ 350 per child

Child Name ___________________________________        M/F          Age when camp starts _______

Address    _______________________________________________________________________

                 _______________________________________________________________________

Have you participated in River Pointe Summer Camp before? when:_____________________________

Parent / Guardian name _____________________________________________       Member:  Y / N

Cell Phone _____________  Night Phone _____________ email: _____________________________

Emergency Contact:

1) Name: ________________________________Relation: ____________  Phone ______________

2) Name: ________________________________Relation: ____________  Phone ______________

Liability Waiver:  Pirate camp is not for the faint of heart! Your child must be between the ages of 6 and 14 and  must be in good physical condition and must be a good swimmer.  There are certain dangers involved with the game of golf, water sports and other activities performed during Pirate Camp. The parent / Guardian or participant  will not hold River Pointe Golf Course , Jos Bekkers or any other employees / volunteers / participants  involved liable for any accidents or injuries resulting from this camp.   The event details are subject to change at any time.

Registration Options:

1) On April 1st, appear in Person with $ 100 payment and completed registration form ( recommended)

2) After April 1st, Fax in your completed registration form and call in with credit card payment

3) After April 1st, Mail in your registration with $ 100 check made to "River Pointe Pirate Camp"

Registration is on a first come first serve basis

Parent / Guardian Signature: _____________________________   Date: ___________________

River Pointe Pirate Camp, 801 River Pointe Drive, Albany GA 31701wriverpointegolfcourse.com  

ph:229-883-4885  fax: 229-883-0022     email: josbekkers@bellsouth.nets