2012 Southern California Junior Golf Players Club
PLEASE COMPLETE ALL LINES ON FORM

Name of Junior_____________________________________________________________________________
_ M______ F______
Address______________________________________________________________City________________________Zip________
Home Phone__________________________ Dads Cells_________________________ Moms Cell____________________
Juniors age____________ Date of Birth__________________ HS Graduation Year___________________________

Mothers Name______________________________________Email__________________________________________________
Dads Name__________________________________________Email__________________________________________________
Please list any medical conditions that your child has:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

Doctors Name ____________________________________Contact #________________________
In case of emergency, we need permission to seek medical care for your child(s)  Yes__No__

Mothers Signature_______________________Fathers Signature_______________________

Southern California Golf Schools, all of its staff members, directors, agents, escorts, owners, instructors, successors,
golf facilities and assignees are to be free from liability, claims or other forms of legal action including costs arising
there from, against any incident which results in or arises out of loss of property or personal injury including death,
which may be sustained by the junior golfer, parent, myself or the undersigned during travel to, from and or
participation in any Southern California Golf School, Menifee Valley Golf School, Southern California Junior Golf
Players Club, any Valley Junior Golf events, or lessons and tutoring sessions.

Juniors Signature_________________________________Date__________________________

Parent Signature_________________________________Date_________________________

2012Membership Fee $49.00
Make Checks Payable to Steve Bean

951 286-0027 Office  / 909 838-4383 Mobile
email: socalgolfschools@ymail.com
Notice to Parents
Before you run out and buy a set of clubs for your children. Please take some time and consider having
them custom fit for
FREE. We have an agreement with Pacific Golf Clubs in Riverside. They will do a FREE
junior and adult club fitting and build a custom sets of clubs for your junior golfer at or below the best
pricing at the local golf stores. Remember bad fitting golf clubs deter a child from getting better.
If you have any questions please call us in the office at 951 286-0027.

Thanks Pacific Golf Clubs from
Southern California Golf Schools Staff