Western Lakes 2008 Junior Golf Registration Form
Please return registration form with payment to:	Western Lakes Golf Club
	c/o Junior Golf
	W287 N1963 Oakton Rd.
	Pewaukee, WI 53072

Childs Name	Age	Program (Circle One)	Group (Circle One)
__________________________________	____	1 2 3 4	A B C D E F G H I J K L M N O
__________________________________	____	1 2 3 4	A B C D E F G H I J K L M N O
__________________________________	____	1 2 3 4	A B C D E F G H I J K L M N O

Parents Name	__________________________________________________
Address	__________________________________________________
City	_____________________	State	______	Zip	_______________
Home	(_____)______-_________
Work	(_____)______-_________
Mobile	(_____)______-_________
Parents Signature	____________________________________		Date		_____________
In Case of Emergency
Name	____________________________________
Home	(_____)______-_________
Work	(_____)______-_________
Mobile	(_____)______-_________

The undersigned are the parents or legal guardian of			________________________________, a minor
			________________________________, a minor
			________________________________, a minor
and do hereby release and absolve the Western Lakes Golf Club, PGA Golf Professional Greg Johnson, its employees and agents from any and all liability resulting from an injury sustained by said minor(s) or any property damage from accidents that might occur while participating in the Western Lakes Golf Club Junior Golf Program and its activities. Should minor(s) need medical attention during the Western Lakes Golf Club Junior Golf Program and activities, the onsite administrator or another person designated by the onsite administrator has my permission to take the necessary steps to ensure his/her health, well-being, and/or measures deemed necessary and appropriate.
Parent/Legal Guardian Signature		____________________________________		Date	_____________
(must be signed for minor(s) to participate)
Questions???????…. Please call our PGA Golf Pro, GREG JOHNSON at (262) 691-0900 ext #1

Amount Enclosed	$__________	Ck #	_______
OR
Credit Card #	____________________________________
Credit Card Type	____________________________________
Name on Card	____________________________________	Expires	_____/_____