| Membership Type: |
| Membership Type | |
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| Gender: | Female Male |
Ethnicity:
(select all that apply) | |
| Birthday: |
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| School: | |
| Grade Level: | |
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| Emergency Contact: | |
| Emergency Contact Relationship: | |
| Emergency Contact Home Phone: | |
| Emergency Contact Work Phone: | |
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| Parent/Legal Guardian: | |
| Parent Email: | |
| Parent Phone: | |
Participant Consent Form Completed:
(select all that apply) | |
Health Information In the event that I cannot be reached in an emergency, I agree to accept any and all determinations of need for medical assistance
and/or administration of medical attention deemed necessary by The First Tee Chapter representatives. I hereby give permission to the
medical personnel selected by The First Tee Chapter representatives to secure any and all medical, hospitalization, dental, and/or
surgical treatment. In event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the
parent or guardian.
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| Initial | |
| Equipment
I understand that any golf equipment received for use is the property of The First Tee program, and may be returned at the discretion of The First Tee facility upon the termination of the participant's involvement in the program. |
| Initial | |
| Media Release I hereby give The First Tee Chapter, Headquarters Office and participating agencies permission to use film, video tape and/or photographs of the above mentioned minor for lawful promotional or infomational purposes. |
| Initial | |
I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee sponsored activities. I assume all
risks 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 Headquarters
Office, its 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.
Payment of check or credit card will serve as parent/legal guardian consent for participation through this online registration form.
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| Parent/Guardian Signature: | |
| Witness Signature: | |
