STUDENT INFO Student Name* Student Age/DOB* Boy/Girl* BoyGirl
Current School* Do you have clubs?* YesNo
How much golf experience do you have? (example 0-1 yrs, 1-2 yrs)* Medical Conditions (list any allergies, medical conditions or medications we should be aware of)*

PARENT INFO Name(s)* Telephone Number* Email Address* Home Address* Emergency Contact/Relationship*

CONSENT AND WAIVER FORM
I consent to my child participating in lessons, practices, and events at the GreenTee Golf Academy.* YESNO I acknowledge that golf is a physical activity and assume all risks involved.* YESNO I authorize academy staff to seek emergency medical care if required.* YESNO
Date and Initial*

MEDIA RELEASE
I consent to promotional photos or videos of my child being used for GreenTee Academy purposes.* YESNO

CLASS SCHEDULE: Week 1: March 16th-20th | Week 2: March 23rd-27th

Times: 9AM - 12PM | 1PM - 4PM

Age Group* 5-8 YRS OLD8-11 YRS OLD11-14 YRS OLD
Gender* BoyGirl
Class Preference
Preference for Week 1: March 16th-20th* 9AM - 12PM1PM - 4PM Preference for Week 2: March 23rd-27th* 9AM - 12PM1PM - 4PM

Any further notes for the academy

SINATURE AND DATE
Signature*

Clear

Date*
*Required Field