Girls Scholarships Form
Kooringal Golf Club
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Address
*
Street Address
Street Address Line 2
City
State
Postcode
Name of your Primary/Secondary School
*
Parent/Guardian Email
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Child's Mobile Number
Including your child's phone number is optional
Any allergies, medical conditions, or taking any medications? If yes, please provide the details below.
*
Current Handicap
Golfing Goals - Short Term
*
Golfing Goals - Long Term
*
Group Chat
I give consent to be added to a Girls Scholarship Group chat.
I give consent for my child to be added to a Girls Scholarship Group chat.
Parents/guardians are required to complete the following:
I give consent to using child's name and image including photography for general marketing and promotion activities
In case of an injury or emergency, I consent to the Club making any arrangements they deem necessary.
Signature of Parent/Guardian
*
Submit
Should be Empty: