Tregnan Golf Academy - City of Los Angeles Department of ...
Tregnan Golf Academy - City of Los Angeles Department of ...
Tregnan Golf Academy - City of Los Angeles Department of ...
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Junior Tour - Summer 2014First Name ________________________ Last Name________________________Address __________________________ <strong>City</strong> _______________ Zip _________Home Phone ( ) ___________________ Emergency Phone ( ) ______________Mother/Guardian ____________________ Father/Guardian ___________________Male ( ) Female ( ) Age ____ Birth Date __________ Email _______________Are you New ( ) or Returning ( )Junior Tour at Roosevelt <strong>Golf</strong> CourseJunior Tour at <strong>Los</strong> Feliz <strong>Golf</strong> Course__Thursday 4:00-6:00pm Class ID 1049__Tuesday 4:00-6:00pm Class ID 1050__Thursday 4:00-6:00pm Class ID 1051Director’s Approval ______________________________________________Family <strong>Golf</strong> - Summer 2014Child’s First Name _______________________Last Name________________________Adult’s First Name ______________________ Last Name________________________Address _______________________________ <strong>City</strong> _______________ Zip _________Home Phone ( ) ___________________Emergency Phone ( ) ______________Child Only! Male ( ) Female ( ) Age _____ Birth Date ___________________Session <strong>of</strong> choice: ( )Session 1: July 6, 13, 20,& 27 10:00am-11:30am( )Session 2: Aug. 3, 10, 17, & 24 10:00am-11:30am( )Session 3: July 6, 13, 20, & 27 12:00pm - 1:30pm( )Session 4: Aug. 3, 10, 17, & 24 12:00pm - 1:30pm( )Session 5: July 6, 13, 20, & 27 2:00pm - 3:30pm( )Session 6: Aug. 3, 10, 17, & 24 2:00pm - 3:30pmPARENT CONSENT FORM FOR JUNIOR TOUR AND FAMILY GOLFI, the undersigned, give permission for my child, whose name appears above, to participate in the <strong>Tregnan</strong> golf program. Iunderstand the nature <strong>of</strong> sports activities and the minor’s experience and capabilities and believe the minor to be qualified, ingood health, and in proper physical condition to participate in such activity. I give permission for my child to be transported by<strong>City</strong> vehicles as a part <strong>of</strong> his or her participation in the <strong>Tregnan</strong> <strong>Golf</strong> <strong>Academy</strong> program. I agree to relieve the <strong>City</strong> <strong>of</strong> <strong>Los</strong> <strong>Angeles</strong><strong>Department</strong> <strong>of</strong> Recreation and Parks, its <strong>of</strong>ficer agents and employees from any liability in connection with any injury to my childin connection with my child’s participation.I, the undersigned parent <strong>of</strong> _________________________________________, a minor, do hereby authorize <strong>City</strong> <strong>of</strong> <strong>Los</strong><strong>Angeles</strong>, <strong>Tregnan</strong> <strong>Golf</strong> <strong>Academy</strong> as agents for the under-signed to consent to X-ray examination, anesthetic, medical or surgicaldiagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specializedsupervision <strong>of</strong> any physician licensed under the provisions <strong>of</strong> the Medical Practice Act on the staff <strong>of</strong> a licensed hospital, whethersuch diagnosis or treatment is rendered at the <strong>of</strong>fice <strong>of</strong> said physician or a said hospital. It is understood that this authorizationis given in advance <strong>of</strong> any such diagnosis, treatment or hospital care which the aforementioned physician in the exercise <strong>of</strong> hisbest judgement may deem advisable. This authorization shall remain effective for the duration <strong>of</strong> the program, unless revokedsooner in writing and delivered to the <strong>Academy</strong>’s Executive Director.I understand that the program carries no insurance. I understand that I will be responsible for equipment provided by the programand that all equipment remains the property <strong>of</strong> the junior golf program.I agree to allow the use <strong>of</strong> any photographs and or images <strong>of</strong> my child participating in any sponsored event for any promotionaland/or marketing materials.Persons authorized to pick my child up are: I give my permission for my child to sign him/herself out? Yes NoName _________________________ Address _____________________________________ Phone ________________Name _________________________ Address _____________________________________ Phone ________________Signature <strong>of</strong> Parent or Legal Guardian __________________________________ Date _______________