1872 Golf Club Junior Waiver & Release

1872 Golf Club Junior Waiver & Release

Required for every junior member under 18 (ages 2–17). Signed by the parent or legal guardian.
Parent / Legal Guardian
Full Name

First NameMiddle NameLast Name
Email
example@example.com
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Relationship to Junior
Junior
Junior Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Allergies or Medical Conditions
Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Junior
Rules, Acknowledgments, and Waivers
Juniors under 12 must have a parent, guardian or adult they approve on site for the entire visit. The adult does not need to play. Juniors 12–15 may be dropped off and play on their own once this waiver is signed. Juniors 16–17 may play on their own. Junior hours: weekdays 2–8 PM, weekends and holidays 10 AM–8 PM.
I acknowledge the supervision rules
If my junior is 12 to 15, I authorize them to visit and play at 1872 Golf Club without a parent or guardian present.
Code of conduct
I acknowledge the code of conduct
Assumption of risk and release of liability
I have read and agree
Photo/video consent
Electronic Signature
Damage to Property

I accept financial responsibility for any damage my junior causes to 1872 Golf Club property, including simulator screens, projectors, launch monitors, hitting mats, clubs, furniture, walls and ceilings, beyond normal wear from proper play. I agree to pay the reasonable repair or replacement cost, and I authorize 1872 Golf Club to charge it to the card on file for my membership after notifying me with a description and cost of the damage.
Parent / Legal Guardian Electronic Signature
Printed Name

First NameLast Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

1872 Golf Club Junior Waiver & Release

Parent / Legal Guardian

Junior

Emergency Contact

Rules, Acknowledgments, and Waivers

Electronic Signature