Orlando Junior Golf Club
        Jeff Jones PGA

AFTER SCHOOL GOLF PROGRAM

Florida After School Golf Registration

Please complete all information below, enter initials, click SUBMIT, then click PAY NOW button below to comlete registration.

Child's School:
Child's First Name:
Child's Last Name:
Parent Name:
Address Street 1:
Address Street 2:
City:
State:
Zip Code: (5 digits)
Emergency Contact Phone:
Second Emergency Phone:
Email:
Child's Height::
Child Golfs Right          Left
Child's Grade Level:
Special Medical Concerns:

GENERAL RELEASE

The child (participant) and his/her guardian, in consideration for child's school, Orlando Junior Golf Club, Jeff Jones, for providing facilities, instruction, and supervision in the activity listed above does hereby:


Assume all risk of possible damage or injury involved through participation in the above noted activity.


Request permission to participate in the activity with full knowledge that said activity could result in damage or injury to me.


Agree to indemnify and hold harmless the child's school, Orlando Junior Golf Club, Jeff Jones, and or its departments, employees, sub-contractors or agents from liability resulting from any participation in said activity.


Agree to have above listed child picked up no later than 5 minutes after the completion of the class.  The instructor will supervise students not picked up on time and late parents will be charged $15.00 per each 15 minutes they are late.

I acknowledge that I have read and that I fully understand each and every one of these provisions in this release of liability and indemnification agreement and agree to abide by them.


By typing my initials in this box, I, the parent/guardian of child (participant), agree to the above General Release.

 


Initials:

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