First Tee 4-H Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We're excited for our new 4-H partnership at Douglass Park Golf Course! Please complete this form to secure your child's spot in the class. If you would like to receive information on other opportunities through 4-H, enroll today! Enrollment is $15 and scholarships are available. Please contact Rachael at smith630@purdue.edu to request a scholarship or if there are any questions.

Child First Name *

Child Last Name *

What best describes your child's gender? *

Male

Female

Non-Binary (not a girl or a boy)

Other

Prefer not to answer

Please enter your child's address. *

City *

Zip Code *

Child's Birthdate *

YYYY

What is your child's race/ethnicity?

Hispanic, Latino, Latinx, or Spanish

Middle Eastern or North African

White or Caucasian

Black or African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

I don't know, or I prefer not to answer

Multi-Racial

Other:

Clear selection

Do you qualify for free/reduced lunch at school? *

Yes

Parent Name *

Parent Cell Phone Number *

Parent Secondary Phone Number

Parent Email *

Which session will your child be attending? *

Does your child have any allergies, disabilities, or other conditions that our coaches should be aware of? *

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

How long has the participant been playing golf? *

Will the child you’re registering need to borrow golf clubs?

Yes - Right Handed

Yes - Left Handed

Yes - Ambidextrous

Clear selection

Waiver: I, the parent/legal guardian of the above named youth, give approval for participation in First Tee - Indiana sponsored activities during calendar year 2021. I assume all risks of injury whatsoever and agree to hold harmless First Tee Chapter and Headquarters Office from claim(s) of any nature arising from any activity, including transportation, connected with First Tee facility or program. This hold harmless agreement includes, but is not limited to, any claim due to injury approximately resulting from negligence of First Tee Chapter or Headquarters Office, its employees, agents, LPGA and PGA Professionals, participating agencies, and volunteers. I consent to First Tee Chapter and Headquarters Office communicating information regarding my child’s participation via the internet. This consent form is valid for all activities of First Tee of Indiana for the calendar year of 2022. *

Media Waiver: I, the parent/legal guardian of the above named youth, give approval for participation in First Tee - Indiana sponsored activities during calendar year 2021. I assume all risks of injury whatsoever and agree to hold harmless First Tee Chapter and Headquarters Office from claim(s) of any nature arising from any activity, including transportation, connected with First Tee facility or program. This hold harmless agreement includes, but is not limited to, any claim due to injury resulting from negligence of First Tee Chapter or Headquarters Office, its employees, agents, LPGA and PGA Professionals, participating agencies, and volunteers. I consent to First Tee Chapter and Headquarters Office communicating information regarding my child’s participation via the internet. This consent form is valid for all activities of First Tee of Indiana for the calendar year of 2021. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of PGA HQ and sections - all Google users. Report Abuse

Forms