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: *

Gender

Age: *

Skill Level

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