RSVP Adaptive Golf Macon THURSDAY Dec. 12

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OAKVIEW GOLF COURSE

Address: 128 Oakview Club Dr, Macon, GA 31216

COMMUNITY CLINIC: 10:30 am to 12:00 pm

COACHES / VOLUNTEERS BRIEFING: 8:30am coffee/juice/fruit

David Windsor: 678-961-4742

Please check all boxes that apply *

Yes, I plan to attend Thursday, Dec 12

Can't make it? Kindly email us a quick hello OR submit this form so we know.

I am an Adaptive Golf Participant

I am a Coach Volunteer / Peer Mentor

I am a Coach Professional; PGA, LPGA, USGTF

I am a Therapist Professional; PT, OT, CTRS

Other:

Required

Your First and Last name *

Your email address *

Mobile number entered with dashes, Example: 813-111-5555 *

Participants please indicate your impairment category or categories that apply *

Neurological/TBI/Stroke/Impaired Balance

Limb Absence/Limited Use

PTSD

Sensory: Vision/Hearing Impairment

Spinal Injury/Wheelchair/Assisted Device

Cognitive/Intellectual Impairment

Short Stature

Recent Surgery/Joint Replacement

Volunteer attending to support where needed

Other:

Required

Guest names if applicable

How did you hear about this clinic? *

We provide clubs for the clinic, do you own clubs? *

Yes will bring them

No will need clubs

Required

Any other info you'd like to share

In case of emergency, please list a name, phone number & relationship below:

Participant Consent and Release Form:
*

Due to the nature of this golf event, I acknowledge all the foregoing risks on my behalf and accept personal responsibility for any illness, injury or damage that may occur with my attendance. I release, waive, and hold harmless the Georgia State Golf Association, Adaptive Golf Academy, host golf facility, sponsoring organizations and any instructors, directors, staff, other participants and/or supporters involved with a GSGA event. I grant permission to photograph/film video for purpose of marketing, promoting future adaptive golf programs. I am 18 years or older, agree to the above release and sign it voluntarily for myself and on behalf of "Participant" listed herein on this registration form.*

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