Paper Registration Form
Summer 2017
1. Parent / Guardian Information
First Name
Middle Initial
Last Name
Suffix
Relationship to Participant(s)
Primary E-Mail
Secondary E-Mail
Street Address
City
State
Postal Code
Country
Home Phone
Work Phone
Mobile Phone
Other Phone
Preffered Contact Method
____ Phone
___ E-Mail
2. Participant Information
First Name
Middle Initial
Last Name
Suffix
Gender
Date of Birth
School Name
Grade (Number)
Shirt Type
____ Adult ____ Kids
Rev. 3/17
Ethnicity ___ African-American ___ Hispanic
___ Asian American
___ Pacific Islander
___ Caucasian
___ Other
___ Do not wish to respond
Shirt Size
____ S ____ M ____ L ____ XL ____ 2XL
The First Tee of Central Ohio - www.tftco.org
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Paper Registration Form
Summer 2017
Participant's E-Mail Address
Street Address
City
State
Postal Code
Country
Emergency Contact Information
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
Please indicate any participant allergies or physical concerns that we should be aware of below.
Additional Information
Eligible for free/reduced lunch?
____ Yes
____ No
How did you hear about us?
____ Website
____ Kidslink
____ 10TV PSA
____ Word of Mouth
____ Other (please explain using space below)
Rev. 3/17
Household Income
____ Below $10,000
____ $10,000‐$24,999
____ $25,000‐$49,999
____ $50,000‐$74,999
____ $75,000‐$99,999
____ Above $100,000
____ Don't wish to respond
The First Tee of Central Ohio - www.tftco.org
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Paper Registration Form
Summer 2017
3. Disclaimers
Medical Disclaimer
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 Chapter
representatives. I hereby give permission to the medical personnel selected by The First Tee Chapter
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.
Please initial to approve Medical Disclaimer
Equipment Disclaimer
I understand that any golf equipment received for use is the property of The First Tee program, and may be
returned at the discretion of The First Tee facility upon the termination of the participant’s involvement in the
program.
Please initial to approve Equipment Disclaimer
Media Release Disclaimer
I hereby give The First Tee Chapter, 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.
Please initial to approve Media Release Disclaimer
Hold Harmless Agreement
I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee of Central
Ohio sponsored activities during calendar year 2017. I assume all risks of injury whatsoever and agree to hold
harmless The First Tee Chapter and Headquarters Office from claim(s) of any nature arising from any activity,
including transportation, connected with The First Tee facility or program. This hold harmless agreement
includes, but is not limited to, any claim due to injury proximately resulting from negligence of The First Tee
Chapter or Headquarters Office, its employees, agents, LPGA and PGA Professionals, participating agencies,
and volunteers. I consent to The First Tee Chapter and Headquarters Office communicating information
regarding my child’s participation via the internet. This consent form is valid for all activities of The First Tee of
Central Ohio for the calendar year of 2017.
Please initial to approve Hold Harmless Agreement
Rev. 3/17
The First Tee of Central Ohio - www.tftco.org
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Paper Registration Form
Summer 2017
4. Payment
Select which class you are registering for:
All classes are 8:30am – 12pm on Tuesdays (June 6 – August 8) or Thursdays (June 8 – August 10) at
Blacklick Woods Golf Course (BLKWDS). Lunch is provided at the end of class.
For more information about our class levels, please visit the Programs page on our website.
Target Level - $149 - All those NEW to The First Tee ages 5-6
PLAYer Level - $149 - All those NEW to The First Tee ages 7-18
A PLAYer Level - $149 - Students who participated last summer.
A1 PLAYer Level - $149 - Students who participated during the past two summers or more.
Par, Birdie and Eagle Levels - $149
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SUM-17 BLKWDS Target Tuesdays
SUM-17 BLKWDS PLAYer Tuesdays
SUM-17 BLKWDS A PLAYer Tuesdays
SUM-17 BLKWDS A1 PLAYer Tuesdays
SUM-17 BLKWDS Par Tuesdays
SUM-17 BLKWDS Birdie Tuesdays
SUM-17 BLKWDS Eagle Tuesdays
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SUM-17 BLKWDS Target Thursdays
SUM-17 BLKWDS PLAYer Thursdays
SUM-17 BLKWDS A PLAYer Thursdays
SUM-17 BLKWDS A1 PLAYer Thursdays
SUM-17 BLKWDS Eagle Thursdays
Financial assistance is available to those who qualify.
____ I am interested in applying for financial assistance
Payment Method
____ Cash (in person)
____ Check
____ Credit Card
Make Checks Payable to The First Tee of Central Ohio and mail to the following address:
The First Tee of Central Ohio
Student’s Full Name
7309 E Livingston Ave, PO Box 3
Reynoldsburg, OH 43068
____ VISA
____ MasterCard
Credit Card Number
____ American Express
____ Discover
Expiration Date (MM/YY)
CVV #
Billing Address
City
State
Postal Code
Cardholder Signature
Date
Rev. 3/17
The First Tee of Central Ohio - www.tftco.org
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