| 2013 Southern California Junior Golf Players Club PLEASE COMPLETE ALL LINES ON FORM Name of Junior______________________________________________________________________________ M______ F______ Address______________________________________________________________City________________________Zip________ Home Phone__________________________ Dads Cells_________________________ Moms Cell____________________ Juniors age____________ Date of Birth__________________ HS Graduation Year___________________________ Mothers Name______________________________________Email__________________________________________________ Dads Name__________________________________________Email__________________________________________________ Please list any medical conditions that your child has: __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Doctors Name ____________________________________Contact #________________________ In case of emergency, we need permission to seek medical care for your child(s) Yes__No__ Mothers Signature_______________________Fathers Signature_______________________ Southern California Golf Schools, all of its staff members, directors, agents, escorts, owners, instructors, successors, golf facilities and assignees are to be free from liability, claims or other forms of legal action including costs arising there from, against any incident which results in or arises out of loss of property or personal injury including death, which may be sustained by the junior golfer, parent, myself or the undersigned during travel to, from and or participation in any Southern California Golf School, Menifee Valley Golf School, Southern California Junior Golf Players Club, any Valley Junior Golf events, or lessons and tutoring sessions. Juniors Signature_________________________________Date__________________________ Parent Signature_________________________________Date_________________________ 2013 Membership Fee $49.00 single / $79.00 Double 951 286-0027 Office / 909 838-4383 Mobile email: socalgolfschools@ymail.com |
