Registering Additional Siblings

Please use the form below to register additional siblings.

2022 Group Lessons Registration Opens March 15!
The group lessons are held at The Learning Center Galloping Hill Golf Course, 3 Golf Drive, Kenilworth, NJ.

Scheduled for every Wednesday from 6:00-7:30 pm beginning May 4 through July 27, 2022. Pitch and Putt league every other Sunday, June, July, and August.

* First Name (Junior):

* Last Name (Junior):

* Main Contact E-mail (Parent / Guardian):

* Address (Junior):

* City (Junior):

* State (Junior):

* Zip Code (Junior):

* Choose a HOME BASE!:

Age (Junior):

* Main Contact Name (Parent / Guardian):

* Main Contact Phone Number (Parent / Guardian):

* Main Contact Work Number (Parent / Guardian):

* Secondary Contact Name (Parent / Guardian):

* Secondary Email (Parent / Guardian):

Junior Contact Email:

* Does your child have any medical conditions/allergies we should be aware of?:

* Emergency Contact / Relationship:

* Registered Golfers Full Name:

* PayPal Payee Name (for tracking purposes):

* Current School:

* Current Grade:

* High School Graduation Year:

* Do you have golf clubs? (if not, they will be provided):

* Do you play for a School Golf Team (Yes or No)?:

* LIST Other Junior Golf Affiliations:

* What is your GHIN Number?:

* Ethnic Group (Statistics):

If paying with a corporate, please list the business name here.:

If you are a returning participant, please let us know the year last attended.:

* I read and agree to the WAIVER AND RELEASE Statement listed below.:

Yes

* I read and agree to the PARENT / GUARDIAN STATEMENT Statement listed below.:

Yes

* I read and agree to the DISPUTE RESOLUTION Statement listed below.:

Yes

* I read and agree to the MEDICAL EMERGENCY STATEMENT Statement listed below.:

Yes

* I read and agree to the PHOTO & PRESS RELEASE Statement listed below.:

Yes

WAIVER AND RELEASE:
Acknowledging that participation in athletics carries risk of physical injury, I agree that Renaissance Junior Golf, Inc., Galloping Hill Golf Course, Kemper Sports and County of Union, its agents, commissioners and employees, shall not be liable to me for any injury or damage, howsoever caused, resulting directly or indirectly from my participation in the Galloping Hills programs, at any time preceding, during or after the program is in session and I hereby discharge Galloping Hills Golf Course, its agents, commissioners and employees from all actions, claims, and demands I may have for such injury or damage. I authorize that Galloping Hill Golf Course and Greater Newark Girls Golf have the right to use all photographs or videos taken of me during the academy and tournaments for advertising or promotional material. My signature indicates my acknowledgment of and agreement with the terms of this waiver.

PARENT / GUARDIAN STATEMENT
I will be responsible for my child’s personal belongings and equipment and will not hold releasees responsible for their loss.
My child will treat the facilities and equipment provided by LPGA-USGA Girls Golf with care. I understand that I will be assessed for any damage to facilities or equipment caused by my child’s acts or omissions.
I understand that, GIRLS GOLF ONLY WELCOMES POSITIVE SUPPORT from spectators, we want this to be a positive & good experience for all.
I am aware that Girls Golf of Phoenix follows the USGA Rules of Golf during tournament events.

DISPUTE RESOLUTION
I, being parent/guardian of the participant agree that Florida law shall govern any and all disputes involving the Releasees. Furthermore, in the event that a dispute arises out of or relates to my child/ward’s participation in any LPGA-USGA Girls Golf program or activity, I hereby agree to settle such dispute by binding arbitration which shall be held in Daytona Beach, Volusia County, Florida, in accordance with the Commercial Arbitration Rules of the American Arbitration Association. A judgment rendered by the arbitrator(s) shall be final and non-appealable, and may be entered in any court having jurisdiction thereof.

MEDICAL EMERGENCY STATEMENT
I, being parent/guardian of the participant: (i) give my permission for my child/ward to receive emergency medical treatment, if necessary, as a result of participation in any LPGA-USGA Girls Golf program(s) or activity(ies); and (ii) agree to indemnify, waive, release, covenant not to sue, and forever discharge Releasees from any and all liability or claims arising out of such treatment.

PHOTO & PRESS RELEASE
I, being parent/guardian of the participant do hereby grant permission throughout the universe in perpetuity to Releasees to utilize my child/ward’s likeness, image, voice, and/or words incidental to any pictures, television, radio, videotapes, recordings, film, the Internet, or any other form or medium now known or hereinafter devised without compensation, payment of royalties, notification, or permission. I further understand and irrevocably agree that (1) these materials will become the property of Releasees and will not be returned to me; (2) Releasees may edit, alter, copy, exhibit, publish or distribute photos for purposes of publicizing or promoting Releasees, its programs, or for any other lawful purpose; and (3) I waive any right to inspect or approve Releasees’ use of my child/ward’s likeness, image, voice, and/or words.