2017 Junior Registration Form
Junior Name:
NCGA/YOC#:
Parent/Guardian Name:
Address:
Phone: (
)
Email:______________________________________________________________
2nd Email:
Birthday:
/
/
Age:
I hereby consent that my son/daughter, _____________________, participate in the below
activity, and I hereby execute the Agreement, Waiver, and Release on his/her behalf. I state
that said minor is physically able to participate in said activity. I hereby agree to indemnify
and hold the persons and entities mentioned above free and harmless from any loss, liability,
damage, cost, or expense that they may incur as a result of the death or injury or property
damage that said minor may sustain while participating in said activity.
I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND
FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF
LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE ABOVE DISTRICT AND
I SIGN IT OF MY OWN FREE WILL
Parent or Guardian Signature:
*LASPO ACES ALPHA PROGRAM ($295 Annually)
Date Enrolled
__________
*LASPO ACES BETA PROGRAM ($225 Monthly)
Date Enrolled
__________
LAS POSITAS DELTA SPRING/FALL PROGRAM ($65 Mo.)
Date Enrolled
__________
*LAS POSITAS DELTA SUMMER PROGRAM ($145)
Date Enrolled
__________
*LAS POSITAS GAMMA PROGRAM ($495, or Season 1 or 2 $300)
Date Enrolled
__________
*Youth on Course included, must be registered for ALPHA, BETA, DELTA Summer, or GAMMA Program.
Pro Shop Only
Check #:_____________
Cash: ________________
Date Received: ________
Please Remit Checks to:
Total Paid
__________
Juniors at Las Positas 917 Clubhouse Drive Livermore, CA 94551