| Information Requested |
| Ethnicity (select all that apply) | African-American
Asian-American
Casucasian
Hispanic
Native America
Pacific Islander
Other
|
| Birth Date |
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| School District | |
| School | |
| Grade Level | |
| Right Handed Or Left Handed | Right Hand Left Hand |
I heard The First Tee from
(select all that apply) | |
|
Health/ Disability Information
|
|
| Parent/ Legal Guardian | |
| Relationship | |
| Parent/ Legal Guardian | |
| Relationship | |
| Phone (Work) | |
| Phone (Home) | |
| Phone (Cell) | |
| Form Completed by | Mother Father Legal Guardian |
| Most recent Youth Golf League level | 3 Hole Short
3 Hole Long
6 Hole Short
6 Hole Long
9 Hole Regular
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| TFTP LEVEL | Par I or II (Min. age 9)
Birdie (Min. age 11)
Eagle (Min. age 12)
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| In the Event that I can not be reach in an emergency, I agree to accept any and all deteminations of need for medical assistance and/or adminstration of medical attention deemed necessary by The First Tee Chapter representatives. I hearby give permission to the medical personnel selected by The First Tee Chapter representatives to secure any and all medical, hospitalization, dental and/or cost shall be the responsibility of the parent or guadian. |
| Emergency Contact | |
| Relationship to Child | |
| Work Place | |
| Emergency Phone Contact Number | |
| Alternate Emergency Contract Number | |
| (Alt.) Relationship to Child | |
| (Alt.) Emergency Phone Number | |
| Parent/Guardian Initals | |
| I hearby give the The First Tee Chapter, Headquarters Office and participating agencies permission to use film, video tape and or photographs of the above mentioned minor lawful promotional or informational purposes. |
| I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee sponsored activities. I assume all risk of injury whatsoever and agree to hold harmless The First Tee Chapter and Headquarters Office from claim(s) of any nature arising from any activity, including transportation, connected with The First Tee facility or program. This hold harmless agreement includes, but is not limited to any claim due to injury proximately resulting from negligence of The First Tee Chapter or Headquaters Office, it's employees agents, LPGA and PGa Professionals, participating agencies, and volunteers. I consent to The First Tee Chapter and Headquarters Office communicating information regarding my child's participation via the internet.
I consent to allow my child (named above) to participate in pre and post clinic anonymous surveys.
The purpose of the surveys is to quantify the impact of TFTP Life Skill Curriculum for programming assessment and fundraising purposes. |
| Parent/Guardian Signature | |
| Date |
|
| Payment will be due on the first day of the Participant's Schudeled Clinic.
*$65 per participant for all 6 sessions (Household Income - $50,000 and above)
*40 per participant for all 6 sessions ( Household Income - $49,000 and below)
Financial aid and scholarships available based on need
* Certification is held quaterly and is required to advance to the next level. |
| Youth Golf League Fee | $75 per participant for all 9 sessions (Household Income-- $50,000 and above)
$40 per participant for all 9 sessions (Household Income----- $49,000 and below)
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| PAYMENT IS REQUIRED.PARTICIPANT SPACES ARE LIMITED.A PARTICIPANT SPACE WILL NOT BE HELD WITHOUT PAYMENT IN FULL. | |
Name and Email Address Asscociated With Paypal Account
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