Parents Name:

Parents Address, City, State and Zip Code:

Member Golfers Name, Birthdate, Boy/Girl and Birthdate:

Parents Telephone Number & Cell:

Parent's E-mail address:

Members E-mail address:(If applicable)

SCGA Handicap Index No: (If Applicable)

General Skill/Experience Level of Junior Member:

Check if Club Member Interesting in becoming Club Officer.

Parent check if willing to assist in committees and/or administer club activities.

Parent, check if you agree with our consent release of all liability against the Junior Club.

Comments: