Clone of Junior Golf Clinic Registration Form

Welcome to our fall PGA Jr League

League play will be held in September, October and November:

Every Tuesday - 4:00-5:30pm

Inter-squad tournament will be held - Tuesday 10/20, 4:00-6:30pm

Registration fees: $350 (inlcludes a hat)

Student Information

Students Name

First NameLast Name

Age

Parent/Guardian Information

Name

First NameLast Name

Home or Cell Number

Area CodePhone Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.

How did you hear about us?

Release from Liabilities:

You assume your child may be at risk and danger incidental to the game of golf and the golf lesson and release the Golf Professionals, golf course, owners, employees and agents thereof from any and all liabilities resulting from such cases. Jacob Lusk (and other Golf Professionals) are running this camp at Camarillo Springs Golf Course.The golf course is not responsible for any liabilities arising out of this program nor does it know the details of the program. You do not pay the course but to the Professionals. The Golf Professionals are not responsible for children arriving early or picked up late.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Clinic Registration Fee

League Fee - Credit Card Payment$350.00

League Fee - Cash/Check/VenmoFree

Please contact Jacob directly if you are opting to pay via cash/check or venmo - $350

Credit Card

PGA Junior League Registration -Fall 2026

Clinic Registration Fee

Credit Card