NEPGA JUNIOR TOUR
TOURNAMENT APPLICATION
TOURNAMENT NAME:______
PLAYER INFORMATION (PLEASE PRINT)
Name:______Date of Birth (mm/dd/yyyy):______Current Age:______
Gender: M / F ______Email:______Phone:______
Address:______City______State______Zip:______
Division (√): ___Boys 18-21 (Graduates Division) ______Boys 16-18 ______Boys 14-15 ______Boys 12-13 ______Boys 11 & under (9 holes)
_____Girls 14-18 ______Girls 13 & under (9-holes)
Note: Age will be calculated on September 1, 2012.i.e. if your child turns 14 before September 1, 2012 then he/she will play in the 14 year old Division
PARENT / GUARDIAN INFORMATION (PLEASE PRINT)
Name:______Relationship to player:______
Home phone #:______Email address: ______
Primary Emergency Contact (PEC):______PEC Cell Phone #:______
PAYMENT INFORMATION (American Express, MasterCard, Visa)______Cardholder Name:______
Card #:______
Exp date:______3-digit security code (back of card-4 digits on front for AMEX):______Fee: $125(√)______
Signature:______
RELEASE FORM
APPLICANT/PARENT/GUARDIAN
I, ______, wish to enter the 2012 NEPGA Junior Golf Program and do hereby agree that all applications for entry are subject to acceptance by the NEPGA. The applicant and the parent/guardian certify: 1) that the applicant is an amateur player, as defined by the USGA; 2) that the conditions of entry have been read and agreed to; 3) The undersigned applicant and parent/guardian herby release the NEPGA, PGA of America, NEPGA tournament staff, the host site, and any and all sponsors from any and all liability associated with acts or omissions of such parties, or with accident or injuries sustained by the applicant or parent/guardian without limitation in connection with the NEPGA Junior Golf Programs. 4) The applicant grants and assigns his/her individual media/photo rights respecting participation in all events, without exception to the sponsors, NEPGA, and the PGA of America.
CODE OF CONDUCT PLEDGE AND VIOLATIONS
I, ______, agree to observe the USGA Rules of Golf. I agree to practice proper Golf Etiquette at all times. I agree to observe and abide by any and all rules and conditions of the competition as mandated by the NEPGA, including but not limited to all the rules in the 2012 Players Handbook. I understand that my membership may be suspended or cancelled for willful disregard of the Rules of Golf, Golf Etiquette, or dishonest, unsportsmanlike or unbecoming conduct. I understand and agree that all decisions of the NEPGA are final. I understand that in the event of disqualification, suspension or termination of membership, any and all fees and membership dues that have been paid are non-refundable.
Abusive or foul language, club throwing, cheating, disrespectful behavior toward volunteers, officials, host club members or fellow participants, abuse of the golf course, drug or alcohol abuse, smoking or chewing tobacco products, failure to adhere to and abide by the dress codes of either the NEPGA or the host facility, or any other conduct deemed inappropriate by the New England may result in the termination of membership and or suspension of playing privileges.
If a NEPGA Junior Program member violates the Code of Conduct, any or all of the following will occur:
1.Verbal warning to player and parents.
2.Immediate disqualification of the member from the event where violation occurs, including, if deemed necessary by the NEPGA Official in Charge, immediate removal of the player and/or parents/guardians from the premises.
3.Suspension from one or all-future events including termination in full of Membership.
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P.O. Box 743 67A Shrewsbury St. I Boylston, MA 01505P: 508-869-0000 I F: 508-869-0009 I