FIRST TEE

REGISTRATION

Youth First Name:*

Youth Last Name:*

Gender:*

MaleFemale

Street Address:*

City:*

State:*

Zip Code:*

Birthdate (mm/dd/yyyy):*

Grade Completed:*

TFT Level Certified In:*

None
PLAYer
Par
Birdie

Ethnicity (optional):

Parent/Legal Guardian:*

Parent/Guardian Email:*

Other Email:

Home Phone:

()-First three digitsSecond three digitsLast four digits

Work Phone:

()-First three digitsSecond three digitsLast four digits

Mobile Phone:

()-First three digitsSecond three digitsLast four digits

Other Phone:

()-First three digitsSecond three digitsLast four digits

Clubs Needed:*

Yes (clubs will be provided at no charge if needed)
No

T-Shirt Size:*

Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL

Emergency Contact:*

Emergency Contact Relationship:*

Emergency Contact Phone:*

()-First three digitsSecond three digitsLast four digits

Session Preference:*

LITTLE DUFFERS (Age 4-7) @ Moccasin Creek 11:00-12:00 Saturdays
LITTLE DUFFERS (Age 4-7) @ Moccasin Creek 12:15-1:15 Saturdays
PLAYer Level 1 (Age 7 & up) @ Moccasin Creek 8:30-9:45 Thursdays
PLAYer Level 2 (Past PLAYer level experience-Age 7 & up) @ Moccasin Creek 8:30-9:45 Thursdays
PLAYer GIRLS ONLY (Age 7 & up) @ Moccasin Creek 8:30-9:45 Thursdays
PLAYer Level 1 (Age 7 & up) @ Moccasin Creek 10:00-11:15 Thursdays
PLAYer Level 2 (Past PLAYer level experience-Age 7 & up) @ Moccasin Creek 10:00-11:15 Thursdays
PLAYer GIRLS ONLY (Age 7 & up) @ Moccasin Creek 10:00-11:15 Thursdays
PLAYer (Age 7 & up) @ LEE PARK 8:30-9:45 Wednesdays
PLAYer (Age 7 & up) @ LEE PARK 10:00-11:15 Wednesdays
PAR (PLAYer graduates age 9 & up) @ Moccasin Creek 11:45-1:00 Thursdays
PAR GIRLS ONLY (PLAYer graduates age 9 & up) @ Moccasin Creek 11:45-1:00 Thursdays
BIRDIE (PAR graduates age 11 & up) @ Moccasin Creek 1:15-2:30 Thursdays
EAGLE (BIRDIE graduates age 13 & up) @ Moccasin Creek 9:00-10:15 Wednesdays

Releases Agreed Upon:*

***PLEASE READ BEFORE SUBMITTING REGISTRATION***

Medical Release:
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 the event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the parent or guardian.

Media Release:
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.

I, the parent/legal guardian of the above named youth, give approval for participation in The First Tee sponsored activities. I assume all risks of injury whatsoever and agree to hold harmless The First Tee Chapter, golf course(s), and Headquarters Office from claim(s) of any nature arising from any activity, including transportation, connected with The First Tee facility, golf course(s), 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, golf course(s) and Headquarters Office communicating information regarding my child's participation via the internet.

BY SUBMITTING THIS REGISTRATION I AM AGREEING TO THE ABOVE TERMS.

Enter security code:

Send payments to:
First Tee of South Dakota
Moccasin Creek Country Club
4807 130th Street NE
Aberdeen, SD 57401

COST: $70 per CHILD
LITTLE DUFFERS: $35 per CHILD
Maximum $175 per family

Financial Assistance Available:
Contact Dean Zahn at (605) 226-0989 or dean@MoccasinCreekcc.com

JUNIORS DO NOT HAVE TO BE MEMBERS OF EITHER COURSE TO PARTICIPATE!!

4807 130th Street NE Aberdeen, South Dakota 57401 Tel: (605) 226-0900 Golf Shop: (605) 226-0989 Fax: (605) 226-1523 info@moccasincreekcc.com