Blind Golf Canada 2021 Junior Membership Form

Please forward your fully completed membership form to:

Annual Junior Memberships are free of charge to all juniors ages 7-18

Blind Golf Canada

C/o Darren Douma

516-25th Ave. S

Creston, BC

V0B1G5

Juniors Full Name: ………………………………………..

Parents/Guardians

Names……………………………………………………………………………………….

Street Address: ……………………………………….

City: ………………………… Province: ……………. PC: ………………..

Email: ……………………………………..

Primary Phone: …………………….. Cell Phone: ……………………………

Gender: (Please Circle) Male Female

Date of Birth Month…………./Day-…........./Year………………………….

Child’s Dexterity: Left-Handed: …………. Right-Handed ………………..

Child’s Current Height: ……………………………..

Child’s CNIB#........................................................

Parent/Guardian Signature …………………………………………..

AUTHORIZATION SOCIAL & PRINT MEDIA PUBLICATIONS

I, _____________________ the undersigned grant permission to Blind Golf

Canada to take pictures/videos of my child…………………………….. and his/her coach

at all golf events. Further, I grant permission to allow Blind Golf Canada to share

/post/publish any photos of my child& their coach in all social and print media

publications. I will also provide any photos or videos to Blind Golf Canada at their

request to share in all publications. SITGNED: _______________________

Signed and Dated on: ……………………………………..

2021 JUNIOR GOLF CLINIC Calgary, Alberta

OFFICIAL REGISTRATION FORM

Child’s First Name: _______________ Last Name: _________________

Parent/Guardian’s Name: _____________________________________

Mailing Address: ____________________________________________

Home Phone: ___________________ Mobile: ____________________

E-Mail Address: _____________________________________________

Child’s Age: ___________ Gender: Male________ Female__________

Child’s Dexterity: Left-Handed: __________ Right-Handed ___________

Child’s Height: ________________

CNIB#________________________________

Registration Agreement:

I, _____________________would like to register my child,

__________________ for the junior golf clinic being hosted on

July 13thh at Inglewood G.C. I also agree/approve WCBGA/BGC sharing

any photos/videos of my child on the BGC website, BGC Facebook page,

or in any media print/video related to WCBGA/BGC blind golf

promotions.

SIGNED BY: _____________________________ DATED: ____________

PLEASE EMAIL COMPLETED FORM TO: thedoumas71@gmail.com

For any questions, Email OR Phone Darren at (250) 428-8715