Deadline for Registrations Is June 1, 2017

Deadline for Registrations Is June 1, 2017


2017/18 - 5th – 8th Graders


Kids may wear tennis shoes on the course. Golf Balls provided. Kids will need a set of clubs and will carry their clubs.


Players First & Last Name: ______

Gender: Male Female Date of Birth:______

Grade 2017/18 Year______Must be in 5th, 6th, 7th or 8th Grades for the 2017/2018 school year.

Players Address:______City:______State: _____ Zip:______
Contact Phone Number:______This will be the contact number for the coach.

Parent/Guardian #1:______Relationship to Player: ______


Cell Phone: ______Home: ______

Email Address:______

URICRA has teamed up with the Riverdale High School Golf Program to offer an instructional golf camp, July 24-28, 2017 from 4:00- 7:00 p.m. After instruction, the kids can play 9 holes of golf with adult supervision. If the player does not want to play the 9 holes they should be picked up at 5:30.

When: July 24-28 4:00-7:00 p.m.

Where: Byron Hills Golf Course – kids will meet the instructor at the practice green

Instructional camp fee-$20

9 holes after instructional camp-$50

After the camp, the kids will play 8 weeks of competitive golf for $80.00.

9 holes of golf on Sundays at 4:00 p.m. Three players will golf with an adult supervising and keeping score.Players will compete individually within their age groups:

5th & 6th Graders will tee off from the women's tee box 7th & 8th Graders will tee off from the whites.

If the player has a golf membership at Byron Hill’s all greens fees will be waived. (Please inquire at Byron Hills for this membership.) Kids with golf membership will just pay a $20 camp fee.

_____ Check here if your child has a membership at Byron Hills. Membership #______

My child will attend and participate in:

______$20.00 Instructional Camp - July 24-28

______$50.00 for 9 holes of golf after Instructional CampJuly 24-28

______$80.00 for 8 weeks of 9 Hole Golf Competition on Sunday afternoons starting August 6.

(No golf on Sunday after Tug Fest or Sunday of Labor Day weekend.)

$______TOTAL mail check payable to URICRA and this form to PO BOX 8, Port Byron, IL 61275

Contact Larry Cullisonat with questions regarding the golf program.

Please consider volunteering to coach. We will need one parent/coach to walk and coach with3 players to observe and give golf instructions to the players.

Volunteer’s Name:______Phone # ______

Please Read and Sign at the bottom:

Waiver: I certify that my child has insurance coverage for all medical and hospital expenses that might result from an injury during participation in any URICRA activity and do hereby agree to assume all expenses incidental to any injuries and do hold said URICRA, its Board Members, the Rock Island County Forest Preserve or Byron Hills Golf Course harmless.

Parent/Guardian Signature______