TEE TIME & CULINARY YOUTH SUMMER PROGRAM
Registration Form
Registration Form
This is an Summer program where young embark on an exciting journey of learning, skill development, mentorship and character building through golf and culinary. Our program is meticulously designed for teenagers aged 13 to 18, regardless of their skill level or background. Program will be thre days a week begining on July 14, 2026 to August 4, 2026. Culinary will be CM2 Headquarters, 50 N. Hamilton St., Poughkeepsie, NY 12601 Tueasday & Thursday 3:30pm - 5;30pm. Golfing at McCann Memorial Golf Course, 155 Wilbur Blvd, Poughkeepsie, NY 12603-4919 Days: Saturday 11:00am - 12:30pm. If you have any coments questions or concerns please contact us at (845)-768-6998) or check our website which is located @CommunityMatters2.org
Student Information
Student Name:
*
Last Name
First Name
Birth Date
*
Please select a month
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Please select a year
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Year
Gender
*
Please Select
Male
Female
N/A
Age
*
How will your child get home after the program? (Golf must be picked up and dropped off.)
*
Pick Up
Walker
Require a provided ride after program
Allergies(type ''None" if no allergies)
*
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to student
*
Mother or Father
Aunt or Uncle
Grandparent
Legal Guardian
Other
Phone Number
*
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
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Emergency Contact info
Incase of an emergency, and you cant be reached who is the second best person we should contact
Primary Contact Name(First& Last)
*
Relatioship to your student?
*
Brother or Sister
Family Friend
Mother or Father
Grandparents
Aunt or Uncle
Legal Guardian
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Parental Consent
Authorization for Emergency Medical Treatment In the event of a medical emergency, every attempt will be made to reach your emergency contacts first. If medical treatment is needed, 911 will be called. In case of an emergency injury or illness, I authorize Community Matters 2 Inc. to call the paramedics. I authorize Community Matters 2, Inc. to obtain emergency transportation and treatment for my child in the event that myself or the emergency contacts cannot be reached. Consent for Photography/ Media Release agree to grant Community Matters 2, Inc. has full permission to use any photographs, video recordings, or other media of any event that contain my likeness for the purpose of promoting CM2 or for any purpose deemed appropriate by the organizations. Images may be included for editorial, trade, advertising and any other purpose and in any manner and medium, without restriction. I hereby release Community Matters 2, Inc., their legal representatives and assignees, from all claims and liability relating to said photographs. Please sign your acceptance (release) of the various forms of distribution to be utilized by Community Matters 2, Inc Accident Waiver and Release of Liabilty Form In consideration for participation in this program, I release from liability and waive my right to sue Community Matters 2, Inc., their employees, officers, volunteers, community partners, and agents from any and all claims, including claims of the Community Matters 2, Inc’s negligence, resulting in any physical injury, illness or economic loss I may suffer or which may result from my participation in this program, travel to and from the program or any events incidental to this program. I hereby assume all of the risks of participating in any and all activities associated with this program that my child is participating in. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the program holders, sponsors, and organizers of the program in which I may participate, and that it will govern my actions and responsibilities at said program.I agree to hold Community Matters 2, Inc., and all volunteers and representatives thereof, harmless from all claims, loss or damage to my personal property, liabilities, and costs, including attorney’s fees, as a result of my participation in this program, including travel to and from the program or any events incidental to this Program.The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.
Consent (Parent/Guardian if applicable)
*
Yes
No
Name
*
First Name
Last Name
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COVID-19 RISK INFORMATION CONSENT
I understand that COVID-19 is a global pandemic, highly contagious, and spreads through person-to-person contact. Despite reasonable safety measures in place, I acknowledge the inherent risk of exposure to COVID-19 while attending the Program. I accept this risk and release all associated organizations and their representatives from any claims related to COVID-19.
Consent(Parent/Guardian if applicable)
*
Yes
No
Name
*
First Name
Last Name
Is there anything additional we should know( *Optional)
Date
*
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Month
-
Day
Year
Date
Submit
Should be Empty: