Micah Rudosky Conquistador G.C. 2018 N. Dolores Rd. Cortez Co, 81321
2015 Conquistador Junior Golf Program
June 8th -12th, 2015
8am – 10am
JUNIOR GOLF REGISTRATION FORM
Applicants Name________________________________________________
Applicants Age_____
Applicants Home Phone #____________________________
Parents Work #________________________
Parents Cell #_________________________
E-Mail Address_____________________________________
Parent/Guardian Name_____________________________________________
I agree to assume the responsibility for any accident or injury while the participant is engaged in the Conquistador Junior Golf Clinic and do hereby release and absolve Conquistador Golf
Course and Rudosky Golf LLC, 2018 North Dolores Rd, Cortez, CO, their staff, instructors and supervisors from any and all claims, demands, injuries, damages, actions or causes of action. I

hold harmless of any responsibility, the instructors, facility or any persons involved with this program. I also agree to abide by all rules and regulations established by Conquistador Golf
Course.