Registration Form

Student First Name

Student Middle Name (optional)

Student Last Name

Date of Birth

Gender GenderMaleFemale

School

Grade

Address

City

State/Province

Postal/Zip Code

Mailing Address (if different than above)

Mailing City (if different than above)

Mailing State/Province (if different than above)

Mailing Postal/Zip Code (if different from above)

Student Email (optional)

Student Mobile Number (optional)

Parent Email

Parent Mobile Number

New Field New Field Golf Lessons Skill Building Health and Wellness

Parent/Guardian First Name

Parent/Guardian Middle Name (optional)

Parent/Guardian Last Name

I would like to request financial assistance for this season: September 2024 - August 2025 I would like to request financial assistance for this season: September 2024 - August 2025YesNo

Please explain your financial situation that will require financial assistance in order for your child to participate

Additional Comments/Medical Restrictions/Allergies

Signature

Date of Signature