Cross Creek Junior Golf Association

(CCJGA)

Application for Membership

Name: ________________________________ Birth Date:______________ Age: ______

Address: _______________________________________________________________________

City: ______________________________ State: ____________ Zip: _____________

Home Phone: ____________________ Email: _____________________________________

Mother: _____________________________ Mother Work Phone: _______________________

Mother Cell Phone: ____________________ Mother Email: ____________________________

Father: ______________________________ Father Work Phone: _______________________

Father Cell Phone: ____________________ Father Email: ____________________________

Insurance Company: ___________________________ Policy #: _________________________

PLEASE READ AND SIGN:

I certify that my son or daughter is physically qualified to participate in all Cross Creek Junior Golf Association activities and I will not hold the Cross Creek facility liable for accidental injury to my child.

PARENT OR GUARDIAN SIGNATURE: ______________________________________________

Mail Application for Membership with $25 Check Payable To:

Cross Creek Junior Golf Association

Cross Creek Driving Range & Par 3 Golf

6701 Mahan Drive

Tallahassee, FL 32317