Registration Form

Father's Full Name

Mother's Full Name

Student's Home Address

City

State

Zip Code

Father's Contact Number

Father's Email Address

Mother's Contact Number

Mother's Email Address

Parent Certification

I am supportive of my child’s participation in the Orlando Minority Youth Golf Program. I give my permission for the below named youth to participate in rehearsals and performances as outlined below.

Release of Claims

I hereby release the Orlando Minority Youth Golf Association, their agents, and their sponsors from the claims of any injuries to the above named youth which might occur during participation in any of the following golf activities.

Authorization for Medical Treatment

I authorize the sponsors of this activity, as my agent, to consent to any necessary medical or dental treatment deemed necessary for the above named youth while participating in any of the following golf activities.

Who referred your child/children to the OMYGA Program?

Method of Payment

Cash Check

Amount

Total Amount Paid

Balance

First Name

Middle Initial

Last Name

Birth Date

Male or Female

Student Age

School Attending

Grade

School Phone #

Physician's Name

Phone Number

List Physical Limitations

Medical Record On File?

Yes No

Parent Certification – I am supportive of my child’s participation in the Orlando Minority Youth Golf Program. I give my permission for the below named youth to participate in rehearsals and performances as outlined below.

Youth to Participate

Birth Date

Student Age

Youth to Participate

Birth Date

Student Age

Youth to Participate

Birth Date

Student Age

Youth to Participate

Birth Date

Student Age

Parent to Consent

Date

Contact Number

Release of claims – I hereby release the Orlando Minority Youth Golf Association, their agents, and their sponsors from the claims of any injuries to the above named youth/youths which might occur during participation in any of the following golf activities.

Authorization for Medical Treatment – I authorize the sponsors of this activity, as my agent, to consent to any necessary medical or dental treatment deemed necessary for the above named youth while participating in any of the following golf activities.

I agree to attend golf classes and practice sessions.

I agree to do my best to become the best golfer that I can.

I agree to conduct myself at all times in a manner befitting me as a member of the Orlando Minority Youth Golf Association

I agree to respect my parents at all times. I will not talk in a bad way to them.

I agree to respect my fellow man and his property.

I agree to maintain positive self control at all times.

I agree to use golf as my fun, rather than drugs.

I agree to become the best student that I can be.

I agree to grow up and become the best citizen I can be.

I agree to choose golf rather than crime.

Father's Full Name

Mother's Full Name

Student's Home Address

City

State

Zip Code

Father's Contact Number

Father's Email Address

Mother's Contact Number

Mother's Email Address

Parent Certification

Release of Claims

Authorization for Medical Treatment

Who referred your child/children to the OMYGA Program?

Method of Payment

Cash Check

Amount

Total Amount Paid

Balance

Parent Information Form

Student Registration Form

2025 Parent Consent Form

Student Agreement Form

Medical Information Sheet

Pants & Shirt Sizes

Office

Links

Newsletter

(321) 436 - 6667