Application -Junior Golden Girls

 Please…

*type or print the following information.

*enclose $30.00 payment (payable to GGBC) with your application.

Jr. Golden Girl’s name: ___________________________________

Grade (as of Aug. ’07) _______     Check No. _______

T – Shirt size (circle one): Child   Sm / Med / L

                                Adult  Sm /Med/Lg

Street Address: _________________________________________

  City/State/Zip: _________________________________________

Parent’s/Guardian’s Name: _________________________________

Home phone # _________________ Cell # _________________

Emergency Contact Person _______________________________

Relation to Jr. GG __________________ Phone # _____________

Medical Information:

Family Doctor: __________________ Dr. Phone # _____________

Insurance Company’s Name ________________________

Policy # _________________________

Does your Jr.GG have any known allergies or physical limitations? ___

If so, please describe: _____________________________________

  I release the Golden Girls Organization, the Golden Girls, the Golden Girls booster Club, and Ms. Blaylock/Miss Vallejo for all responsibility for personal belongings or any injury incurred by participants in this event. If a medical emergency occurs and I cannot be contacted, I give my permission for emergency medical care to be given to my daughter.

Parent/Guardian Signature ____________________________________ Date _________

Thank you!!! Thank you!!! Thank you!!! Thank you!!! Thank you!!! Thanks!