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Junior Golf League Registration
Parent Information
Name
*
First
Last
Address
*
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
*
Cell phone preferred
Email
Student Information
How many students will be participating?
*
1
2
3
Name:
*
Student #1
Age:
*
Junior Golf Program
*
Please make a selection
Junior Golf Lessons - Group A
Junior Golf Lessons - Group B
Intermediate Prep League
Advanced Prep League
Has the student played golf before?
*
Yes
No
Name:
*
Student #2
Age:
*
Junior Golf Program
*
Please make a selection
Junior Golf Lessons - Group A
Junior Golf Lessons - Group B
Intermediate Prep League
Advanced Prep League
Has the student played golf before?
*
Yes
No
Name:
*
Student #3
Age:
*
Junior Golf Program
*
Please make a selection
Junior Golf Lessons - Group A
Junior Golf Lessons - Group B
Intermediate Prep League
Advanced Prep League
Has the student played golf before?
*
Yes
No
Does your student(s) have any allergies?
Do you have any other medical concerns you would like to share?
Total
$0.00
Parental Permission
*
I agree
I hereby give my child/children permission to participate in the Quit-Qui-Oc Golf Club Junior Lesson Program. I understand that my son or daughter will participate at their own risk.
CAPTCHA
Phone
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