2014 Youth Golf League

Contact Information
Participant's First Name:
Participant's Last Name:
Address 1:
Address 2:
Address 3:
Postal Code:
How should we contact you ?
Home Phone:
Work Phone:
Email Address:
Best Time to Contact:
Best Place to Contact:
Information Requested
Ethnicity (select all that apply) African-American
 Native America
 Pacific Islander
Birth Date
School District
Grade Level
Right Handed Or Left Handed Right Hand   Left Hand  
I heard The First Tee from
(select all that apply)
 Friend  TV/Media  Attend Previous Clinic  School
Health/ Disability Information
Parent/ Legal Guardian
Parent/ Legal Guardian
Phone (Work)
Phone (Home)
Phone (Cell)
Form Completed by Mother   Father   Legal Guardian  
Most recent Youth Golf League level 3 Hole Short
 6 Hole Short
 3 Hole Long
 6 Hole Long
 9 Hole
 18 Hole
TFTP LEVEL Thursday Night 5:00 pm- 7:00 pm
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
Payment will be due on the first day of the Participant's Schudeled Clinic. *$65 per participant for all 8 sessions (Household Income - $50,000 and above) *35 per participant for all 8 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 $65 per participant for 8 sessions (Household Income-- $50,000 and above)
 $35 per participant for 8 sessions (Household Income----- $49,000 and below)
Name and Email Address Asscociated With Paypal Account
Additional Information
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