STUDENT INFO Name* Telephone Number* Email Address* Home Address* Emergency Contact/Relationship*

GOLF HISTORY What is your main reason for starting GT4A?* How much golf experience do you have? (example 0-1 yrs, 1-2 yrs)* Do you have clubs?* YESNO What is your goal for 2026?* Medical Conditions (list any allergies, medical conditions or medications we should be aware of)*

CONSENT AND WAIVER FORM
I consent to 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 being used for GreenTee Academy purposes.* YESNO

CLASS SCHEDULE
Class Level*:
101201
Class Preference: Choose 3

1st Choice*
Day: --- Select Day ---MondayTuesdayWednesdayThursdayFridaySaturdaySunday
2nd Choice*
Day: --- Select Day ---MondayTuesdayWednesdayThursdayFridaySaturdaySunday
3rd Choice*
Day: --- Select Day ---MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Any further notes for the academy

SINATURE AND DATE
Signature*

Clear

Date*
*Required Field