2017/18 TFTMC MEMBERSHIP APPLICATION (Sept. 2017- August 2018)

Name: ______Male: Female:

First Middle Initial Last

Address: ______Apt. #_____City: ______St: ___Zip: ______

Home Phone: ______Date of Birth: ______Age: ______

School:______Student ID# ______Teacher:______Grade:______

High School Graduation Year: ______Student Email: ______NCGA Ghin #______

Ethnicity: African American o American Indian o Asian/Pacific o Caucasian o Hispanic o Multi Racial o

How did you hear about us? Friend/Family o Fundraiser o Newspaper o Web o Golf in Schools Program o Other: ______

Father’s Name: ______Mother’s Name: ______

Father’s Employer: ______Mother’s Employer: ______

Father’s Work Phone: ______Mother’s Work Phone: ______

Father’s Cell Phone: ______Mother’s Cell Phone: ______

Father’s Email: ______Mother’s Email: ______

Father’s Highest Level of Education: ______Mother’s Highest Level of Education: ______

Primary School o High School o College o Universityo Primary School o High School o College o Universityo

Emergency Contact Person:______Tel Number: ______

Special Concerns: YES or NO - Explain:______

Participation and Travel Permission, Waiver of Liability & After Class Policy

By signing below I agree to allow the child mentioned above to participate in The First Tee of Monterey County (TFTMC)/Intel Computer Clubhouse Network (ICCN)/ Salinas Valley Jr. Golf Association (SVJGA)/ AT&T Junior Golf Association (AT&T) and the activities conducted by said entities including, but not limited to, golf and computer use at Twin Creeks Golf Course. Participation is without assumption of liability of any nature by TFTMC/ICCN/SVJGA/ATTJGA/TCGC and its officers, directors, employees and staff or volunteers, any golf course or driving range or any other facility where the program activities are conducted.

I also hereby give my full permission for the above mentioned child to be transported to and/or from any event being conducted by said entities and individuals and I do hereby release and discharge the above mentioned individuals and entities from any and all claims my child may suffer or sustain, directly or indirectly, in connection with any such transportation or participation.

I herby give my permission for my child to have their picture taken and posted or published as deemed necessary by The First Tee, TFTMC, ICCN, SVJGA and AT&T. TFTMC/SVJGA/AT&T recognizes the responsibility to provide a safe learning environment for all of our participants. To ensure the safety of your child/children, we will take the following action when your child tells us that his/her pick up person has not arrived at their pre-arranged time. We will first call the numbers provided for parental contact, then emergency contact numbers. If we do not have a commitment from a responsible party by thirty minutes after close of regular business hours, or completion of the golf tournament/event we will contact the Monterey County Office of Child Protective Services for assistance in ensuring the safety of your child.

I ______have read and understand the above mentioned release of liability, after class policy and transportation release

PARENTS NAME

and grant the above mentioned child full permission to participate in any events operated and organized by the above mentioned entities.

Signed: ______Date: ______

Emergency Medical and Surgical Treatment

The parent or guardian below does hereby consent to all emergency medical and surgical treatments, including anesthesia and operations, which may be deemed advisable by any treating physicians and surgeons. The intention hereby being to grant authority to administer and perform all examinations, treatments, anesthetics, operations and diagnostic procedures which may now or during the course of the patient’s care be deemed advisable and necessary. I also agree that if the student is admitted to a hospital, he or she is to remain there until the treating physician recommends discharge.

Parent/Guardian Signature: ______Date: ______Accept: Decline:

Membership Fee - $120*

(September 1, 2017 – August 31, 2018)

Sibling Fee - $30**

Full year membership benefits includes:

·  52 weeks of Center for Learning (CFL) access

·  31 weeks of access to golf and life skills classes

·  8 weeks access to 2018 TFTMC Summer Camp (additional fee)

·  Free golf club rentals & use during classes

·  The First Tee Life Skills Experience PLAYer Bag Tag

·  NCGA Youth on Course Membership- upon PLAYer Certification

o  Discounted green fees at more than 80 Northern California courses

o  $1-small /$2-large range balls at TFTMC

o  $1 Green Fees at TFTMC – PLAYer Certified Participants

o  Boys Only Time (BO!) & Girls Only time (GO!) in the JZCH

o  AB Honor Roll (all grades, each semester)

·  National Opportunities: (Teens)

o  Auntie Anne’s Leadership Forum in Walt Disney World

o  Pure Insurance Championship at Pebble Beach

o  The First Tee Life Skills & Leadership Academies

o  Outstanding Leadership Academy

o  IJGA Training Program in South Carolina

o  Coca-Cola America’s Future

o  Scholarship Program

*Pro-rated prices for midyear sign ups **Sibling fee not pro-rated

The First Tee of Monterey County (TFTMC)

Celebrating 13 Years of Positive Impact in Monterey County!

www.thefirstteemc.org

1551 Beacon Hill Drive, Salinas, CA 93905

(831) 444 – 7200 x 216