First _____________________Middle_________ Last Name______________________________

Email ___________________________________________________

Address _________________________________City _______________St _______ Zip ________

Birth date ___/___/___ Gender M ___ F ____ Grade in School ______ Grad Yr ______ Handicap/Avg Score _______

Parents/Guardian ___________________________________________________

Home Ph _______________ Work Ph_______________ Cell phone___________________

Local Newspaper Email address: ________________________________________________
Yes______ I give my permission for my child's name, city, state, and graduation year to be released to the following associations for purposes of national ranking and score posting:
on Junior Golf Scoreboard, www.juniorgolfscoreboard.com.
Or No _____ I do not want my child's graduation year used when submitting scores to Junior Golf Score Board.

WAIVER: I hereby authorize __________________________ to participate in the Triad Golf Today Junior Tour. I understand that the Triad Golf Today Junior Tour, Triad Golf Today magazine as sponsor, volunteers and participating facilities are not liable for accidents or injuries sustained while playing or participating in junior events. I agree to fully indemnify and hold harmless Triad Golf Today Junior Tour, Triad Golf Today magazine as sponsor, volunteers and participating facilities from damages sustained in any event. I FURTHER HEREBY GRANT AUTHORITY TO ADMINISTER FIRST AID OR MEDICAL TREATMENT AS REQUIRED TO THE ABOVE NAMED CHILD WITHOUT THREAT OF LEGAL ACTION.
______________________________ _______
Parent or Guardian Signature date

Entry Fee: $100 - 36 Holes (18 hole format each day)
Make checks payable to: TGTJT Mail to: TGTJT 5410 Mockingbird Rd. Greensboro NC 27406

Will accept Visa or MasterCard (please circle card type)*$3. Processing fee in addition to entry fee
Account #: _________________________________ Code _______
Name as on Card: _____________________________________ Expiration Date: __________________
Signature: _________________________________
**There will be a $25 returned check fee and a $10 declined charge card fee**

Tournament Information:
-Players must be an Atlantic Coast Jr Golf Tour member (see Membership link at www.tgtjt.com)
-Playing age as of June 1, 2009
-Limit 88 players
-Practice rounds: not included but are available through course indicating you are a registered player with Atlantic Coast Jr Golf Tour/TGTJT.
-Spectator carts at course discretion.
- Range balls included
-No jeans or denim allowed and no T-shirts
- Soft spikes only
-*Event must have 25 or more boys playing from the championship yardage (longest set of tees) in order to qualify for TYGA ranking
-*Event must have 8 or more Girls playing from the longest set of tees in order to qualify for TYGA ranking
- Additional tournament information at www.tgtjt.com

Contact information:
Wendell Welch, State AAU Director of Golf - cell (336) 451-0655 office (336) 674-1900
Email: triadgolfjrtour@aol.com Web site: www.tgtjt.com