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2026 Lake Junior Golf Clinic

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Student Registration - $20.00

Parent First Name *

Parent Last Name *

Parent Phone Number *

Email *

Student Last Name *

T-Shirt Size *

Medical Conditions * Are there any medical conditions your child has that we should be aware of?

Emergency Medical Authorization * Yes, in the event I cannot be reached, I grant consent for emergency medical treatment.
No, in the event I cannot be reached, I do not grant consent for emergency medical treatment.

Emergency Contact Name *

Emergency Contact Phone Number *

Preferred Doctor: Name/Number *

Preferred Dentist: Name/Number *

Preferred Hospital *

Grade *

I understand that there are natural risks inherent in participating in sports activities.

I hereby give permission for my registered children to participate in the Lake Junior Golf Clinic. I hereby authorize routine first aid care by staff. I understand that there are natural risks inherent in participating in sports activities. I hereby agree that I will hold harmless and release, exonerate, and discharge any instructor to helping with the clinics, Lake Middle High School, and Lake Local School District for any injuries, illnesses, accidents, or disease my child may suffer while participating in this club or in transporting to or from this club.

By agreeing to this disclaimer, I acknowledge that the student is covered by insurance and that the coaches and school are not liable for injuries incurred during normal club activities.

Signature:

2026 Lake Junior Golf Clinic

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2026 Lake Junior Golf Clinic

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