Acknowledgement of Release Form

							                                                    Intra-City Golf Team
                                                          (Pleasant Valley & Bettendorf)

Season:                                      April 15th - May 9th

Available To:                                Competitive golfers ages 13-18

Program Objective:                           To develop young golfers to better understand the game of golf, and
                                             how to play it at a competitive level. We will work on each individual's
                                             golf swing and how to play the game to fit into their strengths on the
                                             golf course.

Practice:                                    Will be conducted 4:00 – 5:30 every Tuesday, Wednesday & Thursday.
                                             Friday will be a play day and we will finish when 9 holes are completed.
                                             All golfers are required to wear collared shirts and khaki pants or shorts.

 Practices Tuesday- Thursday will include lessons, drills, and repetition, in areas such as; chipping,
  putting, approach shots, full swings, and course management. These days will be very similar to
High School and Collegiate practices. Fridays will be unsupervised but players are expected
                                     to turn in scorecards and conduct themselves appropriately.

Cost:                                        $150 Per Golfer / $125 Season Pass Holder

Team:                                        Our team will consist of the first 16 golfers to respond.

Instructors:                                 Nate Lubs & Alex Schenfeld


JUNIOR NAME__________________SCHOOL DISTRICT_______________
PARENTS NAME______________________________________________
HOME ADDRESS______________________________________________
                 STATE_____
CITY_____________________        ZIP CODE____________________
HOME PHONE_____________________CELL PHONE ____________________
EMAIL ADDRESS______________________________________________
EMERGENCY CONTACT NAME___________________PHONE #__________
Approval and consent by parent or guardian: As a parent or guardian of the applicant, I hereby certify the facts as stated in this entry form and attest that I am
familiar with his/her plans to participate and that he/she does so with my approval. I further certify that, in the event that emergency medical care needs to be
administered to the above named applicant and the below mentioned person cannot be contacted, the required parental consent may be given by an authorized member
of Pebble Creek Golf Course. I further certify that I have read the participant acknowledgement release, waiver and hold harmless agreement and agree to its terms.
                                                 DATE________
SIGNATURE________________________________________________