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Participant Form Participant Information - please print or type - all information is required LPGA-USGA Girls Golf of (city, state) Green Valley Ranch - Denver, Colorado Participant’s Name Address City State Zip Home Phone ( Participant’s Birth Date / / Parent/Guardian Day Phone ( School Grade Parent Email

) )

Consent & Release - Parent or Guardian MUST sign in space indicated below for application to be considered. Parent/Guardian Statement I, the parent (or guardian) of the participant named above, am familiar with the plans and purposes of LPGA-USGA Girls Golf and give full permission for my child/ward to attend LPGA-USGA Girls Golf events and to participate in all phases of LPGA-USGA Girls Golf activities. I understand that, by signing this Consent & Release Form below, I agree to waive and release any rights and claims for damages against, and hold harmless LPGA-USGA Girls Golf, LPGA, The LPGA Foundation, the USGA, and each of their respective officers, directors, employees, volunteers, workers, members and agents, from and against any and all injuries or damages which may result from or arise out of my child’s/ward’s participation in LPGA-USGA Girls Golf events and activities. Dispute Resolution In the event of a controversy or claim arising out of or relating to this Participant Form the undersigned hereby agrees to arbitration held in a mutually agreeable location in accordance with the Commercial Arbitration rules of the American Arbitration Association. A judgment rendered by the arbitrators shall be final and nonappealable, and may be entered in any court having jurisdiction thereof. Medical Emergency Statement I, the parent (or guardian) of the participant, give my permission for my child/ward to receive emergency medical treatment, if necessary, as a result of participation in the LPGA-USGA Girls Golf program. It is understood that every effort will be made to contact me before taking this action. Release of Participant Person(s) other than parent who may pick up the participant at the end of any LPGA-USGA Girls Golf event:

Name

Address

City

Relationship

Day Phone

Night Phone

State

Zip

In Witness Whereof I have read, understand and agree to this entire consent form.

* PARENT/GUARDIAN SIGNATURE REQUIRED

Name

Date

Golfing Experience Please check the level that best describes your ability: Level I:

New Golfer - Very little or no on-course experience.

Level IV: Average between 55-64 for nine holes on a regulation course.

Level II: Able to play hole 125 yards from green.

Level V: Play 18 holes with a score of 110 or better on a regulation course.

Level III: Average between 65-75 for nine holes on a regulation course.

Level VI: Play 18 holes with a score of 95 or better on a regulation course.

Do you own your own clubs?

Other junior golf affiliation

Photo & Press Release I, being Parent/Guardian of ____________________________________________________, hereby consent that any photographs and/or motion pictures or videotape in which my child/ward appears, and any audio recordings made of her voice may be used by LPGA-USGA Girls Golf, its assigns or successors, in whatever way they desire, including television and electronic media; furthermore, I hereby consent that such photographs, films, and recordings, and the plates and/ or tapes, from which they are made shall be their property, and they shall have the right to sell, duplicate, reproduce, and make other uses of such photographs, films, recordings, plates, and tapes as they desire free and clear of any claim whatsoever on my part. ___________ (INITIALS OF PARENT/GUARDIAN)

For statistical purposes only (optional - you are not required to answer): Which of the following best describes your race or ethnic group? Alaskan Native / American Indian

Asian / Pacific Islander

Black or African American

Hispanic

White

Other 1.20.2012


LPGA*USGA Girls Golf Green Valley Ranch 2012 Membership Registration Check the Membership Applicable:

$20 $100 $20

$10 Per Event

The First Tee of Green Valley Ranch Membership

Additional to TFTGVR Registration Fee. Cost includes Membership Kit and participation in all events (except Parent-Daughter Tournament).

Year Long Membership Fee

Cost includes Membership Kit and participation in all events (except Parent-Daughter Tournament).

Pay Per Event

Cost includes Membership Kit and ability to register for individual events at $10 each.

2012 Schedule of Events:

All individual Instruction Days and Play Days can be registered and paid for online. If you are paying per event, and would like to pay for individual events now, check the events below. If you are a TFTGVR Member or Year-Long Member and would like to register for individual events now, check the events below: Instruction Day 4:00-5:00 Monday 5/7 Play Day 4:00-6:00 5/14 Monday Instruction Day 4:00-5:00 Monday 5/21 Colorado Women’s 4:00-5:30 Wednesday 5/30 Open Clinic (FREE) Play Day 4:00-6:00 Monday 6/4 Play Day 4:00-6:00 Monday 6/11 Instruction Day 4:00-5:00 6/18 Monday Play Day 4:00-6:00 Monday 6/25 Movie Night! 7:00-9:00 Thursday 6/28 Play Day 4:00-6:00 Monday 7/9 Instruction Day 4:00-5:00 Monday 7/16 Play Day Monday 4:00-6:00 7/30 Parent/Daughter 4:00-6:00 8/6 Monday Tournament! Instruction Day 4:00-5:00 8/13 Monday Play Day 4:00-6:00 Monday 8/20 End of Year Party! 9/6 Thursday 4:00-5:30 (FREE) $

Membership Fee

$

Events to Pay For - Per Event Membership ONLY (# of classes X $10 = total)

$

TOTAL Please complete the entire application and return with payment to: Colorado Open Golf Foundation ● The First Tee of Green Valley Ranch 20309 E. 48th Pl., Denver, CO 80249 ● Phone (303) 486-8800 ● Fax (303) 486-8823 Make Check Payable to: Colorado Open ● A $25 fee will be charged for returned checks


PARTICIPANT AGREEMENT 1. 2. 3. 4. 5. 6. 7.

I will respect the environment and the people with whom I come in contact and will try to be sensitive to the needs of each participant in LPGA-USGA Girls Golf. I understand that the use of alcohol or illegal drugs will not be tolerated and that usage during any LPGA-USGA Girls Golf event will result in expulsion from both the program and the event. I will be responsible for my personal belongings and equipment and will not hold LPGA-USGA Girls Golf, LPGA, The LPGA Foundation, the USGA or their employees responsible for their loss due to my negligence or abuse. I 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 negligence or abuse. I will use any safety equipment furnished by LPGA-USGA Girls Golf for my own safety. I understand that if I am sent home early due to any serious misconduct, it will be at my expense, and LPGA-USGA Girls Golf will make my travel arrangements. I will comply with the LPGA-USGA Girls Golf Code of Ethics.

_____________________________________

____________________________________

________________

_____________________________________

____________________________________

________________

Participant’s Name (Please print)

Participant’s Parent/Guardian Name (Please print)

Participant’s Signature

Participant’s Parent/Guardian Signature

Date

Date

THIS AGREEMENT MUST BE SIGNED BY THE PARTICIPANT AND PARTICIPANT'S PARENT/GUARDIAN

LPGA-USGA GIRLS GOLF CODE OF ETHICS Treat others as you would like to be treated Replace divots

Rake bunkers and repair ball marks so you leave the course better than you found it Club throwing, swearing, cheating, littering or smoking are not acceptable Always thank the host professional

GG6.3.11


2012 LPGA Registration Form