Calvary Men of Standard
Youth Golf Academy Registration
Student Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Gender: (Male / Female)
example: Male
Age:
example 12
Date of Birth
-
Month
-
Day
Year
example: 01-06-2010
Handiness: (Left/Right):
example: Right
Shirt Size
Please enter shirt size by gender (example: boys large)
School and Grade
example: Morristown (8)
Golf Experience
example: Yes: 1 Year
Known Medical Condition
Please describe in detail medical condition and any medication taken and/or needed
Parent/Guardian Name
First Name
Last Name
Parent Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Parent/Guardian Signature
Date
-
Month
-
Day
Year
Date
Contacts for information:
Stan Prater (201-787-5699), Henry Lee (973-202-3871), Milford Nixon (732-735-3147, Roger Williams (610-306-2341)
Submit
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