Quixotic Golf Student Registration and Program Participation Agreement

Where Natural Movement Creates Better Golf

Help us understand your natural movement patterns and golf goals. Your responses allow us to create a development plan that works with your body, not against it.

2025 Quixotic Golf Annual Student Registration & Participation Waiver

This annual registration form collects essential health, safety, and legal documentation required for all Quixotic Golf program participants. Accurate completion ensures we maintain current emergency information while providing the safest learning environment. All information is confidential and used solely for program administration and safety protocols.

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Athlete's Personal Details

For whom are you completing this registration form?

Myself
Another Athlete

Is the person being registered 18 years of age or older?

Athlete's Name

First

Last

Preferred Name (Optional)

Gender

Date of Birth

Program Selection

Medical Information

Does the person being registered have any medical conditions that we should be aware of?

Primary Care Name & Contact

First

Last

Phone

Consent & Agreement

Medical registered Parent/Guardian

Date

Name

First

Last

Signature

Clear Signature

Quixotic Golf Student Registration and Program Participation Agreement

Where Natural Movement Creates Better Golf

Athlete's Personal Details

Parent/Guardian Information

Program Selection

Medical Information

Allergies

Injuries

Physical Challenges

Cognitive Challenges

Consent & Agreement

Medical Consent

Risk Acknowledgment and Waiver

Code of Conduct Agreement

Photo and Media Release

Acknowledgment