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Child's Name: __________________________ Gender: M F Age: _____

Address: ______________________________

City: __________________ State: Michigan Zip: ___________

Home Phone: ______________________ Cell Phone: ______________________

E-mail: ___________________________________

Requested Foursome (if desired)

Child's Name: ______________________ Child's Name: ______________________

Child's Name: ______________________

Note: Bushwood Golf Club, it's staff or volunteers assume no responsibility whatsoever for any injury by the participant in the activity shown above.

Inappropriate behavior may result in dismissal of the golfer for a length of time to be determined by the Bushwood Golf Club Staff. 

Parent or Guardian Signature: __________________________ Date: _______________

*Please make checks payable to Bushwood Golf Club.