Serving those that serve America

Youth & Community Outreach Programs

Pin Pals
Free Six Week Golf Clinic for Military Youth
Return Pin Pals Registration Packet to the Armed Services YMCA
by October 30, 2009 to register for free six lesson clinic

Sundays, November 15 - December 20

Riverwalk Golf Club 2:00 p.m. - 3:00 p.m.

Military youth (ages 10 to 17) learn the fundamentals

of golf in this six week golf clinic. Each lesson,
conducted by PGA professionals, covers the basics of
putting, chipping, pitching and the full swing.
Additional opportunities for course play help junior
golfers continue to develop their game! All necessary
golf equipment provided.

Space is limited. Six week clinic requires attendance to each

lesson. Lessons held at East End driving range of Riverwalk
Golf Club (1150 Fashion Valley Road).

Special thanks to Pin Pals Jr. Links for their continued support of San Diego
military youth through the Armed Services YMCA - Pin Pals sponsorship!

San Diego Armed Services YMCA Visit our website www.militaryymca.com for more information on

3293 Santo Road, San Diego, CA 92124 the over 40 free programs and services available to your family!
 Youth and Community Outreach Department
Release of Liability Form: Adults and Minors

Parent/Guardian Name(s) (print)______________________________________________________________________

Parents Date(s) of Birth (same order)__________________________________________________________________
Address________________________________City_________________Zip____________Military Housing? Yes/No
Email Address________________________________________Service Branch_____________________Rank______
Home Phone__________________________Work__________________________Cell__________________________
Emergency Contact________________________________________________________________________________
EC Home Phone_______________________EC Work_______________________EC Cell_______________________
Minor Children Participating:
Name______________________________________________________________Date of Birth___________________
Name______________________________________________________________Date of Birth___________________
Name______________________________________________________________Date of Birth___________________
Activity or Group____________________________________________________Date(s)________________________
Location_________________________________________________________________________________________

I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the
minor to participate in the San Diego Armed Services YMCA program described above. I hereby grant full
permission for my child and/or myself to be photographed by the San Diego Armed Services YMCA staff for any
legitimate purpose without payment or compensation. The minor is physically able and mentally prepared to
participate in all activities as described in the announcement for the program. I hereby voluntarily and knowingly
assume all risks and dangers inherent and incidental to the activities of the program. I will not hold the San Diego
Armed Service YMCA liable for any injuries incurred during the program or while my child(ren) is/are in transit to and
from the program whether caused by equipment or the act or omissions of others excepting damage or injury solely
caused by the willful misconduct or negligence of the San Diego Armed Services YMCA, or its employees,
volunteers, or agents.

I do hereby authorize the San Diego Armed Services YMCA as agent for the undersigned, to consent with respect to
the minors, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital
care which is deemed advisable by, and is to be rendered under general or special supervision of, any physician
and surgeon licensed under the provisions of the California Medical Practice Act on the medical staff of any hospital,
whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that
the San Diego Armed Services YMCA is not responsible for costs incurred for medical care. If I participate in the
program, whether as coach, instructor, aide, spectator, or participant, I presently waive as to the San Diego Armed
Services YMCA and staff, officers and directors thereof, any claim presently known or unknown for damage to
property or personal injury whether caused by equipment or the acts or omissions of others including San Diego
Armed Services YMCA personnel.

_______YES My child(ren) can receive a healthy snack _______NO My child(ren) cannot receive a healthy snack

Food Allergies, if any:______________________________________________________________________________

****Parent/Guardian (Signature)____________________________________Date___________________****