Moccasin Creek Country Club

The First Tee of South Dakota @ Moccasin Creek & Lee Park
2010 Junior Golf Lesson Program - Registration Form
Please read the Junior Golf Handbook here

Cost: Age 8 - 17 $40.00 per child - Maximum $99 per family
Cost: Age 5 - 7 $20.00 per child - Maximum $99 per family
Financial assistance available - call Amanda at 770-5176 or Dean at 226-0989.
Juniors DO NOT have to be members of either golf course to participate!

Youth Information
Participation:	New Return
T-Shirt Size:

Name:
Gender:	Male Female
Address:
City:
State:
Zip:
Clubs Needed:	Yes No (clubs will be provided at no charge if needed)
Birthdate:	(e.g. 00/00/0000)
Parent/Guardian's Names:
Parent/Guardian's Email:
Phone Number:

Sessions
At Moccasin Creek - Age 8-17 - Players Level - Beginner & Intermediate Session Preference: 8:45 - 10:15 10:30 - 12:00 None Dates: Thursdays - May 27, June 3, 10,14, 17, 24, July 1, 8, 15
At Lee Park - Age 8-17 - Players Level - Beginner & Intermediate Session Preference: 10:30 - 12:00 None Dates: Wednesdays - May 26, June 2, 9, 16, 23, 30, July 7, 14, 21
At Moccasin Creek - Age 12-17 - Birdie Level - Intermediate & Advanced Session: 10:30 - 11:30 None Dates: Fridays - May 28, June 4, 18, 25, July 2, 9
At Moccasin Creek - Age 5-7 - Little Linkster Sessions Session: 11:00 - 12:00 None Dates: Saturdays - May 29, June 5, 19, 26

Health Information
Emergency contact:
Relationship:
Home Phone:
Work Phone:
Cell Phone:
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 and all medical, hospitalization, dental, and/or surgical treatment. In the event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the parent or guardian.
Parent/Guardian Initials:

Media Release
I hereby give The First Tee Chapter, Headquarters Office and participating agencies permission to use film, video tape and/or photographs of the above mentioned minor for lawful promotional or information purposes. I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee sponsored activities. I assume all risks of injury whatsoever and agree to hold harmless The First Tee Chapter and Headquarters Office from claim(s) of any nature arising from any activity, including transportation, connected with The First Tee facility or program. This hold harmless agreement includes, but is not limited to, any claim due to injury proximately resulting from negligence of The First Tee Chapter and Headquarters Office communicating information regarding my child's participation via the Internet.

Parent/Guardian Authorization
Signature:
Date:

The registration fee for this program is $40.00 per child Age 8-17 or $20 per child Age 5 - 7 (maximum $99.00 per family) Financial assistance available - call Amanda at 770-5176 or Dean at 226-0989 Juniors DO NOT have to be members of either course to participate! Cash/Check (collected at time of first lesson) Charge to MC3 account

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