2022 US Kids Player Pathway Program

Runs 9 Weeks

June 13th- August 13 th

*Select One Weekly Session*

Make-up Classes Are On Saturdays

SESSION DATES

Mondays

Level 1 4-4:50 PM

Level 2 5-5:50 PM

Level 3 6-6:50 PM

Wednesdays

Level 1 4-4:50 PM

Level 2 5-5:50 PM

Level 3 6-6:50 PM

Fridays

Level 1 10-10:50 AM

Level 2 11-11:50 AM

Level 3 12-12:50 PM

Saturday

Level 1 Makeup 10-10:50 AM

Level 2 Makeup 11-11:50 AM

Level 3 Makeup 12-12:50 PM

Junior Golfer Information

Student's Name

First Name Last Name

Birth Date

Month Day Year

Grade

Gender

Male Female

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent/Guardian Information

Name

First Name Last Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Stephens Golf Center during the program. In exchange for the acceptance of said child’s candidacy by The Stephens Golf Center., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Stephens Golf Center . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.In case of injury to said child, I hereby waive all claims against The Stephens Golf Center . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including golf.

My Products

Level 1 Registration 9 Sessions Beginning June 6th

$ 200.00 Select One Weekly Session

Level 2 Registration 9 Sessions Beginning June 6th

$ 200.00 Select One Weekly Session

Level 3 Registration 9 Sessions Beginning Week of June 6th

$ 200.00 Select One Weekly Session

Enter coupon

Total

$ 0.00

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

2022 US KIDS PLAYER PATHWAY PROGRAM