Junior Golf Performance Academy Online Registration

Registration

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Welcome! NEW MEMBERS FOR CLASSES/CAMP: Please fill out this form. Once registered, you will be redirected to the parent portal login page where you will log in to enroll your golfer in a class. NEW MEMBERS FOR PRIVATES ONLY: Please fill out this form and then reach out via email infojgpa@gmail.com to receive our Private Booking Link ***IF YOU HAVE ATTENDED A JGPA CLASS OR CAMP BEFORE - PLEASE DO NOT FILL OUT THIS FORM - LOG INTO YOUR PORTAL TO ENROLL FOR CLASSES/CAMPS***

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address

City

State

Zip

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)

Quail Creek/Village Member?*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior golf experience?*

When enrolling in a Summer Camp or Saturday class, 50% of your total due, no matter how many weeks you enroll in, will be required in order to secure your spot. Your 50% due will be charged the Friday following your enrollment. The remaining 50% is due on Monday, May 27th and will be charged automatically.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior golf experience?*

Enroll in Classes

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior golf experience?*

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior golf experience?*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Prior golf experience?*

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Comments

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Please fill out CREDIT CARD Payment Method

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

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Zip*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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