Golf Lesson Information Collection Form

Trestle Creek
Junior golfer information
If you are unable to complete this form please contact:
Blair Wilkie
Text 587.501.9475,
or blairwlkiegolf@gmail.com
Student #1 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Student #2 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Student #3 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Student #4 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Student #5 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Student #6 basic information
First name
Last name
Date of birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Male or female
Other
Address Information
Trestle Creek Lot number
Home/ Winter City
Parent's Information (if participant is under 18)
Parent's/Guardian's name
Email address
example@example.com
Phone number
Parent's/Guardian's name
Email address
example@example.com
Phone number
Emergency Contact 1In the event of an emergency, please contact:
First name
Last name
Primary phone number
Secondary phone number
Emergency Contact 2
In the event of an emergency, please contact:
First name
Last name
Primary phone number
Secondary phone number
Anything Coach should know?
What lesson package are you interested in? What are your Goals?
Should be Empty:

Select theme: