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NSJGA - Membership Application

NSJGA MEMBERSHIP APPLICATION 2014

 

 

NAME:  ___________________________________________________________________________________   

                 (Last)                                  (First)                           (Birth date)          (Age as of 9/1/12)

 

STREET ADDRESS:  _________________________________________________________________________

 

CITY:  ______________________ STATE:  _____________ ZIP CODE:  _____________COUNTY:________  

 

 

EMAIL ADDRESS:________________________________________________________

 HOME PHONE:                (_________) - ____________ - ________________________ 

JUNIOR CELL PHONE:    (_________) - ____________ -________________________      

 

PARENT/GUARDIAN NAME:  ____________________________________________                                                                                                                                                   (First)                         (Last)                      

PARENT/GUARIDAN 1 CELL PHONE:  (______) - ______ - _________

 

PARENT/GUARDIAN 2 CELL PHONE   (______) - ______ - _________

 

SCHOOL ATTENDING:  ___________________________________________   GRADE:  _________________

                                                                                                                                                        (Grade as of 9/1/12)

ANTICIPATED HIGH SCHOOL GRADUATION YEAR:  ______________________

 

HOME GOLF COURSE:  _______________________YEARS PLAYED:  ___________

 

AVERAGE SCORE (18 holes):  _______________    (9 holes):  _______________ 

 

Please check the appropriate tournament division below:

 

Boys and Girls            8 & 9         

Boys Intermediate      10-12         □                

Boys Intermediate      13-18         □ 

Boys Advanced          10-12         □

Boys Advanced          13-15         □                    

Boys Advanced          16-18         □                   

Girls Intermediate      10-18         □                 

Girls Advanced          10-18         □

 

The undersigned and the undersigned’s heirs, executors and administrators, hereby waive and forever release and discharge North Suncoast Junior Golf Association, its officers, directors, employees, agents successors and assigns of and from any and all claims, suits or rights for damages for personal property damage or physical injury which may be sustained by the undersigned’s child or which occurs during the undersigned child’s participation in tournament activities or that may occur to or from tournaments, whether or not such injuries or property damage or loss is caused by, is connected, to or arises out of any acts or omissions or the negligence of the North Suncoast Junior Golf Association, its officers, directors, employees agents, successors or assigns or of the golf courses at which the tournaments are held.

 

___________________________________                           __________________________________

                       Parent’s Signature                                                          Junior’s Signature

 

      Make check payable to SMWCC

Mail or submit completed application with 2014 Rules Test, and $50.00 annual membership fee to:

Sugarmill Woods Country Club

PO Box 3809, Homosassa Fl 34446