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Primary Information (Child)
First Name*  
Last Name*  
Address*  
City*  
State*  
Zip*   
Phone*  
Email*  

Personal Information (Child)
Birth Date*  
Gender*  
Graduation Year*
Health Issues
Family Physician
Home Course
Hometown Newspaper
Skill Level
Stroke Average

Contact Information (Parent/Guardian)
Father's First Name*
Father's Last Name*
Work Phone*

Mother's First Name
Mother's Last Name
Work Phone

NJGC Policy
I hereby authorize the above named child to participate in the National Junior Golf Club. I understand that the National Junior Golf Club, its sponsors, volunteers and participating facilities are not liable for accidents or injuries suffered while playing in the NJGC events. By accepting below, we agree to fully indemnify and hold harmless the NJGC and its volunteers from any damages suffered by the NJGC. I also fully authorize and release the NJGC or any other publication submitted for print in which the NJGC may participate. We have read the enclosed information and we agree to abide by all policies set forth by the NJGC, including those listed on the club website and all members are required to have a valid credit card on file. We fully understand the rules and regulations regarding tournaments, refunds and our cancellation policies. We also understand that all applicants will be screened prior to acceptance into membership.

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