Student Registration / Waiver
All students (current/past/new) are required to completely fill out the Registration/Waiver Form below.

Please answer ALL the questions and press "Send Info". Note: When you press "Send Info", you are acknowledging that you understand the stipulations and risks involved and are releasing all claims. This waiver applies to all participating programs.

If you have any questions regarding this registration, please contact Curt Peterson @ (224) 612-1701.

Thank you.

 

Full Name

Email Address

How did you hear about us?

Comments

Mailing Address

Cell #:

Other #:

 

 

Birthday:

Game Improvement Area 1: (select the MOST important)

Game Improvement Area 2: (select the SECOND most important)

Game Improvement Area 3: (select the THIRD most important)

 

Are you a Right-Hand or Left-Hand Golfer?

Do you currently have a USGA or CDGA Handicap Index?

What is your current USGA - CDGA Handicap?

How many years have you played golf?

Which days of the week are you available for lessons?

How many hours per week can you practice? Practice time includes: at the range, home, the office and on the road (traveling)?

Please list below your TOP 3 GOALS for taking lessons!

Have you had any surgical procedures and/or Physical limitations which may affect your golf swing? (please list any that may apply)

Waiver: I assume the risk and legal liability associated with this golf lesson(s) and waive/release all claims for injuries which I and/or my child or friend's child might sustain as a result of participating in any golf lesson taught by Curt A Peterson.

Please enter below the DATE you agreed and accepted the waiver.

 

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