Name:
_______________________ Home Phone: ___________
Address: ____________________________________________
City:
Email:
______________________________________________
Date of Birth:
___/___/______ Gender: Male ____ Female ____
Graduation Yr:
I have played golf
for _____ years _____ months
I have
participated on my school golf team: Yes ___ No ___
My average score
is ______ for 9 holes ___ or 18 holes ___
My USGA handicap
is ____ at ________________ as of ______
I understand
that I will be required to verify my ability level for placement in tournament
by way of current
handicap card, attested score cards, a letter from a golf professional, or a
skills test to be administered
by the staff and volunteers of the WNCJGA.
Acknowledging
that participation in athletics carries with it the risk of personal injury, I
agree that the
Western North
be liable to me or my child for any injury or damaged, howsoever caused,
resulting directly or indirectly
from my child’s participation in the Western North
during or after the program is in session and I hereby discharge the above named
from all actions, claims
and demands I or my child may have for any such injury or damage. I authorize
that Western North
Junior Golf has the right to use all photographs or videos taken of my child for
advertising or promotional material.
Signature of junior
golfer: _______________________
Date: ___/___/______
Signature of
parent/guardian: _____________________
Date: ___/___/______
IN CASE OF
EMERGENCY NOTIFY:
Name: _____________________ Relationship:
_______
Phone: __________
Family membership (2
or more) $30
I
wish to make an additional donation of _____
in honor/memory of _______________
I
wish to become a drink sponsor ($100)
Y /
N Which
event? __________________
TOTAL
AMOUNT ENCLOSED: _________