Youth Clinic Registration Form

Youth Clinic Registration

Name: *


First	Last

Address: *

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Phone: *

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Area Code	Phone Number

E-mail: *

Emergency Contact:


First	Last

Emergency Contact Phone: *

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Area Code	Phone Number

Gender: *

Time Preference: *

I agree to allow Westhaven Golf Club to use likeness rights (photographs or video) for promotional use that may occur during clinic times. : *

*Payment due on or before first day of clinics and is required to reserve time slot*

Youth Clinic Registration Form