Email Address * "CHILDS" FIRST name * "CHILDS" LAST name * Select Class or Classes from 2 LOCATIONS * Ascarate Golf Skills Only ($52.50) Ascarate Playing on the course ($77.00) Ascarate Both golf skills and Playing ($102.50) Ft. Bliss Golf Course Golf Camp ($77.00)
Ascarate Golf Skills-10:00-12:00 (practice on range, chipping & putting)
Ascarate Golf Course play 1:00-4:00 (playing on the course)
Ft. Bliss Golf Camp -9:00-12:00
Does your child need a scholarship? Yes No Yes a Partial one Participant Gender * Male Female I don't wish to respond Street Address * City * State * Zip Code * Birthdate of Participant * Ethnicity * Caucasian Hispanic or Latino African American Asian Multi-Racial Other School * Grade * Father or Guardian Name Father/Guardian Phone Number Mother or Guardian Name Mother or Guardian Phone Number How did you hear about us? * Health Information * Yes No
Health Information: Are there any medical conditions (allergies, medications, developmental issues, Physical issues, etc) or disabilities that may have a bearing on your child's participation in The First Tee Program? This information will be kept confidential.
If Yes Please explain Emergency Contact Information-NAME * Emergency Contact Phone number * Emergency-Please Initial *
Medical Emergency Statement: 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 the event that such medical attention is needed form a healthcare provider, all costs shall be the responsibility of the Parent or Guardian. (Parent or Guardian Initials:)
Equipment-Please Initial *
Equipment: I understand that any golf equipment received for use is the property of the First Tee of Greater El Paso chapter, and must be returned at the discretion of the First Tee of Greater El Paso upon the termination of the participants involvement in the program. (Parent or Guardian Initials)
Media Release-Please Initial *
Media Release: I hereby give my permission to The First Tee of Greater El Paso chapter, Home Office and their authorized licensees to utilize without compensation or further notice the participant's likeness, image, voice, name and/or their words incidental to any print, photographs, audio, video, television, radio, the Internet, social network or any other form of medium no known or hereafter devised for the purpose of promoting The First Tee of Greater El Paso, their authorized licensees or any other lawful purpose. The media will become the property of The First Tee of Greater El Paso. (Parent or Guardian Initials)
Parent/Guardian Agreement Please Initial *
Parent/Guardian Agreement: I, as the parent/guardian of the above named participant, give approval for his or her participation in The First Tee sponsored activities. In full recognition of the dangers and hazards inherent in a golf and youth development program, I assume all risks of injury whatsoever and agree to release and hold harmless The First Tee of Greater El Paso chapter and the other released parties from claim(s) of any nature arising from any activity, including transportation, connected with The First Tee program. This assumption of risk, release and hold harmless agreement includes, but is not limited to, any claim due to injury or loss proximity resulting from negligence of The First Tee chapter, home office and each of their respective directors, officers, employees, agents, LPGA and PGA professionals, volunteers, youth participants and participating agencies (the released parties) to the fullest extent provided by law. (Parent of Guardian: Type Signature Below)
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