Western Lakes 2010 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
__________________________________ ______
__________________________________ ______
__________________________________ ______
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 _____/_____