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Blackberry Ridge Golf Club

3125 Clubhouse Road
Sartell, Minnesota 56377

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Blackberry Ridge Golf Club © 2024

Junior Golf Registration

Please complete the form below and select which camps you would like
to register for and indicate camp sweatshirt size. Registration and
payment is due by June 1st. Spots are limited.
For more information please call Scott Dirck Golf Academy
at 320-219-7677 or email us at info@scottdirckgolf.com

2024 Summer Junior Golf Registration Form

Child's Name(Required)

First Last

Child's Age(Required)

Parent's Name(Required)

First Last

Phone(Required)

Email(Required)

Medical/Allery Information(Required)

Camp Sweatshirt Size of Choice(Required)

Program 1 $200

9:00-10:00 am - Birdies (age 6-7)

10:15-11:15 am - Eagles (ages 8-9)

11:30-12:30 pm - Albatross (ages 10-12)

Tuesday Mornings June 18/ July 9, 23, 30 / August 6 (Makeup days Aug 13 and Aug 20)

Program 2 $200

9:00-10:00 am - Birdies (age 6-7)

10:15-11:15 am - Eagles (ages 8-9)

11:30-12:30 pm - Albatross (ages 10-12)

11:45-12:45 pm - Mini Masters (ages 4-5)

Thursday Mornings June 6, 13 / July 11, 25 / Aug 8 (Makeup days Aug 22 and Aug 29)

Waiver(Required)

Waiver and Release Form Liability
I agree not to bring any claim, demand, and/or cause of action of any nature whatsoever against Scott
Dirck Golf Academy, or any member, officer, employee or agent for any loss, damages, and injuries
including: 1) any known and unknown, foreseen and unforeseen bodily injury, 2) loss of life, and 3) any
attorney’s fees at trial and appellate levels, and costs, expenses, or charges sustained, directly or
indirectly, or alleged to have been sustained, or in any fashion arising from, in connection with, or
resulting from the athlete’s participation in or association with the Scott Dirck Golf Academy. By
participating in the Scott Dirck Golf Academy Junior Golf Program, you acknowledge and agree that your
photo may be used in future promotional materials.
Indemnity
Further, I will indemnify and hold harmless Scott Dirck Golf Academy or any member, officer, employee
or agent from and against any claim, demand, and/or cause of action of any nature whatsoever, brought
by or on behalf of the Athlete or any member of the Athlete’s family, including, but not limited to the
Athlete’s mother, father, brother, sister, or grandparents, or any lawful blood descendants of the Athlete
for any loss, damages, and injuries including: 1) any known and unknown, foreseen and unforeseen bodily
injury, 2) loss of life, and 3) any attorney’s fees at trial and appellate levels, and costs, expenses, or
charges sustained, directly or indirectly, or alleged to have been sustained, or in any fashion arising
from, in connection with, or resulting from the athlete’s participation in or association with the Junior
Golf Programs. This agreement is binding upon my heirs, successors, or assignees. It may not be
modified orally, and a waiver of any provision shall not be construed as a modification of any other
provision herein or as consent to any subsequent waiver or modification.
I UNDERSTAND THAT THIS CONSENT CAN BE REVOKED AT ANY TIME IN WRITING EXCEPT TO THE
EXTENT Scott Dirck Golf Academy Junior Golf Program HAS RELIED ON IT.

I agree to this waiver.

Release/Waiver Signature(Required)

Must be 18 years or older to sign.

First Last

Child's Name(Required)

First Last