BIRDIE BASICS REGISTRATION FORM
Student Guardian Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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How Many Students Are You Enrolling?
*
Please Select
1
2
3
Please Select A Class Time For Your Family.
*
Please Select
3:40PM - 4:10PM
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Student Information
Name
*
First Name
Last Name
Age
*
Name
*
First Name
Last Name
Age
*
Name
*
First Name
Last Name
Age
*
What is the student's experience level?
*
Beginner
Intermediate
Advanced
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Add Another Email to the Program Email List
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
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Terms and Conditions
*
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Any Other Comments or Questions?
Please Select How Many Students You Are Enrolling:
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( X )
8 Week Birdie Basics Preschool Program
(8) Golf Classes
$240.00
$
240.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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