Youth Information Participant First Name *
* Gender * Male Female Ethnicity * African- American Asian-American Caucasian Hispanic Multi-Racial Native-American Age *
Participants must be at least 7 years old prior to May 31, 2017 to participate in the Spring PLAYer Session
Participant's Birthday * Participant's Grade Level 2016-17 * Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Freshman Sopomore Junior Senior Participant's School * Amanda Arnold Elementary Anthony Middle School Bluemont Elementary Bergman Elementary Central Elementary Creche Eisenhower Elementary Eisenhower Middle School Flint Hills Christian School Fort Riley Elementary Fort Riley Middle School Franklin Elementary Grandview Elementary Home School Jefferson Elementary Junction City High School Junction City Middle School Lee Elementary Lincoln Elementary Manhattan Catholic School Manhattan High School Marlatt Elementary Milford Elementary Morris Hill Elementary Northview Elementary Ogden Elementary Riley County Grade School Riley County High School Rock Creek High Schol Seitz Elementary Sheridan Elementary Spring Valley Elementary St. George Elementary St. Xavier Catholic School Theodore Roosevelt Elementary Wamego High School Ware Elementary Washington Elementary West Elementary Westwood Elementary Woodrow Wilson Elementary Other Other
If your school is not listed above please enter the participants school.
Parent/Guardian Information Parent or Guardian Name *
Email * Second Email
Phone * Phone Participant Consent Form compleed by: * Health Information Health Concerns? *
Example: allergies (bee sings, ants, food), conditions (asthma, type I diabetes), or physical concerns (heart problem, ankle injury). If none applicable, write NA
Emergency Contact *
if parent or legal guardian cannot be reached
Relationship * Emergency Phone Number 1 * Emergency Phone Number 2 Medical Consent, Equipment, Media Release, and Wavier
Read the Consent, Equipment, Release and Waiver Below. Initial in the space provided if you agree to the stated terms.
Medical Consent *
In the event that I cannot be reached in an emergency, I agree to accept any and all determinations of need for medical assistance and/or administration of medical attention deemed necessary by The First Tee of Manhattan representatives. I hereby give permission to the medical personnel selected by The First Tee of Manhattan representatives to secure any and all medical, hospitalization, dental, and/or surgical treatment. In event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the parent or guardian.
I understand that any golf equipment received for use is the property of The First Tee of Manhattan, and may be returned at the discretion of The First Tee facility upon the termination of the participant's involvement in the program.
I hereby give The First Tee of Manhattan, Headquarters Office and participating agencies permission to use film, video tape and/or photographs of the above mentioned minor for lawful promotional or informational purposes.
Waiver of Liability *
I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee of Manhattan sponsored activities. I assume all risks of injury whatsoever and agree to hold harmless The First Tee of Manhattan, Headquarters Office, and Colbert Hills Golf Course from claim(s) of any nature arising from any activity, including transportation, connected with The First Tee of Manhattan. This hold harmless agreements includes, but is not limited to, any claim due to injury proximately resulting from negligence of The First Tee of Manhattan or Headquarters Office, its employees, agents, LPGA and PGA Professionals, participating agencies, and volunteers. I consent to The First Tee of Manhattan and Headquarters Office communicating information regarding my child's participation via the Internet.
Sign Here *
Please type your name here for authorization as an electronic signature