Download Application Form - Beach Grove Golf Club

Please provide all requested information.CN FUTURE LINKS GIRLS’ CLUBPLAYER APPLICATION FORMSITE LOCATION: Beach Grove Golf Club 5946 – 12 th Ave, Delta BC V4L 1C7PROGRAM COORDINATOR:FEE: $100.45 (includes taxes)Mary AdamsPainter Style Hat: Pink - Girls Club logo / Black - Future Links logo (Circle one)HOW DID YOU HEAR ABOUT THE GIRLS’ CLUB? __________________________________________________________NAME:ADDRESS:CITY:POSTAL CODE:BIRTH DATE:PARENTS NAME(S):month/dd/yyAGE:HOME PHONE:CELL:E-MAIL:PLEASE LIST ANY MEDICAL CONDITIONS: _________________________________________________________________Parent’s Signature:Player’s Signature:Payment$100.45 includes hat __pink with Girls Club logo or __black with Future Links logo (select one)Submit form with cheque (payable to Beach Grove Golf Club).Beach Grove Golf Club Members may charge fees to their account.Please charge $ _________ to my account#____________ Signed: ____________________________________Page 1 of 2

PARENT / GUARDIAN PERMISSION FORMGirl’s Name ____________________________has my permission to participate in Girls’ Club Summer Program at BeachGrove Golf Club.In the event of an emergency, if I cannot be reached, the following person is hereby authorized to act on my behalf and hasbeen notified that he/she has been granted this authority.(Name)(Phone number)I have read and understood the information provided with this form. I authorize my child/ward to participate in theactivity as described above.(Date)(Signature of custodial parent or guardian)Relationship to child: _________________________________________RELEASE, WAIVER AND ASSUMPTION OF RISKTo be signed by all custodial parents or guardians of a minor child or by the participant if they have reached the provincialage of majority.We (I) hereby acknowledge and agree that in consideration of being permitted to participate in the activities of CN FutureLinks Girls’ Club (herein called the Association):1. We (I) do hereby release the Association, it’s Members, Officers, Directors, Employees, Volunteers and IndependentContractors from all liability, claim causes of action of any kind whatsoever in respect to all personal injuries, loss of lifeor property losses, which our daughter/ward (I) may suffer out of the activities of the Association.2. And We (I) do hereby Acknowledge and Agree that Summer Program at Beach Grove Golf Club:a. May be dangerous and expose our daughter/ward (me) to risks and hazards.b. That we (I) freely and voluntarily assume all the aforesaid risks and hazards for our daughter/ward (myself).c. That we (I) have carefully read this Release, Waiver and Assumption of Risk agreement, that we (I) fullyunderstand same, and that we are (I am) freely and voluntarily executing same,3. We (I) understand clearly that by signing this Release we (I) will be forever prevented from suing or otherwise claimingagainst the Association, it’s Members, Officers, Directors, Employees, Volunteers, or Independent Contractors withrespect to any matter arising from these activities.(Signature of custodial parent or guardian)(Witness)DATED at: _______________ this ______ day of ____________ in the year 2013Special RequestsWe will endeavour to accommodate any requests to be paired with another girl such as her friend or carpooling. Pleaseindicate the girl’s full name._______________________________________________________Page 2 of 2