StonyCreek Golf Club

IN CONSIDERATION of permitting the student whose name appears below to enroll and participate in golfing activity and class instruction given at StonyCreek Golf Club, Inc. by a member of the StonyCreek golf staff, the undersigned as parents or legal guardians of the student hereby release, discharge, waive, and relinquish any and all actions or causes of action for personal injury or property damage occurring to the student, to the extent such claims might be made against StonyCreek Golf Club, Inc., its officers, staff, employees, and agents, such as damages or injuries arising as a result of participation in this program by the student, wherever or however such injury or damage may occur, and for whatever period said activities or instruction may continue.

It is the intention of the undersigned, as parents or legal guardians of the student by this instrument to exempt and relieve StonyCreek Golf Club, Inc., its officers, staff, employees, and agents from liability for personal injury or property damage caused by negligence.

We, the undersigned, as parents or legal guardians of the student give StonyCreek Golf Club, Inc. permission to publish and print, electronic, or other video format the likeness or image of the student while he/she is participating in golfing activity and class instruction at StonyCreek Golf Club, Inc. We, the undersigned, as parents and legal guardians of the student, additionally release all claims against StonyCreek Golf Club, Inc., with respect to a right of publicity, ownership, and/or publication of such print, electronic, or video image, including but not limited to any claim for compensation to us or our child or legal ward related to the use of such materials.



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Student Name


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Parent or Legal Guardian Signature


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Printed Parent or Legal Guardian Name


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Parent or Legal Guardian Signature


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DatePrinted Parent or Legal Guardian Name


If only one parent or guardian signs for the student, the parent or guardian signing represents to StonyCreek Golf Club, Inc. and its staff that each parent or guardian authorizes this Limitation of Liability and Release.




StonyCreek Golf Club | 11800 East 166th Street | Noblesville, IN 46060 | 317.773.1820 | 317.776.4593 fax | www.stonycreekgolfclub.com