ALBERTA GOLF PLAYER SUPPORT PROGRAM 2018 HIGH PERFORMANCE PROGRAM

Transcription

1 ALBERTA GOLF PLAYER SUPPORT PROGRAM 2018 HIGH PERFORMANCE PROGRAM APPLICATION FORMS

2 TABLE OF CONTENTS Contact Information Page 3 Parent / Guardian Contact Information 4 Medical Authorization Form (18 years and over) 5 Medical Authorization Form (17 years and under) 6 Playing Experience, Education Background 7 Coaching history 8 Player statement 9 Equipment Form 10 References 11 Code of Conduct 12 Release / Waiver 13 Schedule of Events 14 Fee Structure and Payment Schedule 15 Acknowledgement 16 2

3 CONTACT INFORMATION Last Name: Given Name & Initial: Golf Canada Membership Number: Current Index: Player Current Club Affiliation: Previous Club Affiliation (if any): Date of Birth: Place of Birth: Home Address: City: Prov.: Postal Code: Home Telephone: Personal Cell: Player Address: Personal Twitter Handle (if applicable) Instagram Handles (if applicable): Twitter/Instagram Handles at Education Institutions (if applicable): PARENT / GUARDIAN INFORMATION 3

4 Parent/Guardian #1 Information Name: Relationship: Cell Phone: Address: Home Address: Parent/Guardian #2 Information Name: Relationship: Cell Phone: Address: Home Address: (leave blank if same as above) 4

5 MEDICAL AUTHORIZATION FORM (18 years and over) EMERGENCY CONTACT Name: Home Phone: Cell Phone: Name: Home Phone: Cell Phone: HEALTH CARE INFORMATION Physician s Name: Phone: Alberta Health Care Number: Known Medical Conditions: Allergies: Supplemental Health Care Provider: Policy No: Athlete s Signature: Date: 5

6 MEDICAL AUTHORIZATION FORM (17 years and younger) EMERGENCY CONTACT Name: Home Phone: Cell Phone: Name: Home Phone: Cell Phone: HEALTH CARE INFORMATION Physician s Name: Phone: Alberta Health Care Number: Known Medical Conditions: Allergies: Supplemental Health Care Provider: Policy No: Athlete s Signature: Date: Parent s Signature: Date: 6

7 PLAYING EXPERIENCE Indicate playing experience over past two years (if additional space is required, please submit a separate page). Include major tournaments, competitions, championships, etc. Date Event Competitive Level (National, Provincial, etc.) Placing/ Seeding/ Ranking Pts. Field Size* July 18-21, 2017 Alberta Men s Amateur Provincial T Players Number of Years Playing Competitive Golf: 2017 Provincial Order of Merit Ranking: if applicable 2017 National Order of Merit Ranking: if applicable 2017 Overall Scoring Average: competitions only, if applicable World Amateur Golf Ranking (WAGR): if applicable Educational Background High School: University/College: 7

8 COACHING HISTORY Please provide history of coaches over the past 3 years (with contact information) COACH 1 Name: Position: Club/Facility Affiliation: Telephone Number: COACH 2 Name: Position: Club/Facility Affiliation: Telephone Number: COACH 3 Name: Position: Club/Facility Affiliation: Telephone Number: PLAYER STATEMENT 8

9 Indicate your golf-related objectives over the next one to three years. (use additional page if needed) 9

10 EQUIPMENT FORM This information is designed to assist the athlete and Alberta Golf coaching staff evaluate current equipment being used and the athlete s desire to explore alternative equipment. Based on the information submitted along with data and observations made during the skills assessments, coaches will make equipment recommendations for the athlete s consideration in achieving optimal performance. Current equipment summary Make & Model of Driver: Make & Model of other Woods: Make & Model of Irons: Make & Model of Wedges: Make & Model of Putter: Make & Model of Shoe: Make & Model of Glove: Make & Model of Ball: Are you considering exploring the Alberta Golf equipment program? (Y/N) Woods (Y/N): Irons (Y/N): Other: FootJoy Clothing Size: FootJoy Shoe Size: FootJoy Glove Size: Ball (Pro V1 or Pro V1x): 10

11 REFERENCES Please provide two personal references (excluding immediate family members) we would be able to contact in order to confirm all information provided in your application. Reference 1 Name: Position/Relationship: Address: City: Prov.: Postal Code: Home Telephone: Cell: Reference 2 Name: Position/Relationship: Address: City: Prov.: Postal Code: Home Telephone: Cell: 11

12 CODE OF CONDUCT You have been selected to join the Alberta Golf High Performance Program on the basis of your individual athletic merit. Your personal conduct throughout the program reflects on all participants, presenters, PGA of Alberta Professionals and Alberta Golf personnel. It is important that the athlete s behavior, both on and off the golf course, is reflective of the guiding principles of the Alberta Golf High Performance Program. The Alberta Golf High Performance Program Code of Conduct requires that all athletes: - Adhere to individual course dress codes during practice and competitive rounds - Demonstrate respect for fellow competitors, coaches, volunteers, spectators, tournament officials, host venues and Alberta Golf staff - Strictly adhere to the Rules of Golf and appropriate golf etiquette - Refrain from the use of drugs or alcohol at all times during events - Refrain from using personal social media or online accounts to post or create content that is considered offensive, obscene or harassing in nature - Comply with Canada s Anti-Doping Program (CADP) - Refrain from the use of abusive and profane language at events Athlete Signature: Date: Parent Signature (if under 18): Date: 12

13 RELEASE / INDEMNITY WAIVER AND CONSENT (17 years and younger) IN CONSIDERATION of the right of the participant being allowed to participate in the programs sponsored by Alberta Golf, I, (parent s name) and of (city), (hereinafter called the Releasers which term includes our heirs, executors, administrators and assigns), the father and mother and legal guardians of an infant under the age of eighteen years, born on do hereby release and forever discharge Alberta Golf, which includes its successors and assignees, its members, employees, agents and servants, from all manner of action, causes of action, claims or demands by us against the Alberta Golf. AND for the consideration of aforesaid, We, the Releasers, hereby covenant and agree with the Alberta Golf that we will, at all times hereafter, release and save harmless the said Alberta Golf from all claims and demands, suits, or actions or claims for contribution or indemnity which may be made or brought against Alberta Golf by the above named infant, on his/her behalf or in any way arising out of his/her involvement with any activities or programs sponsored by Alberta Golf or any matter incidental thereto. Consent The competitor and/or participant and their parents or guardian do hereby consent to Alberta Golf's use and right to publish in any form any video, still photographs, sound or other records of the competitor, for reporting, advertising, promotional or commercial purposes of any kind. Parent Signature Date 13

14 2018 SCHEDULE OF EVENTS January Introduction & Testing Weekend Tier 3 & 4 February Indoor - North & South Team Training Weekend Tier 3 & 4 March Indoor - North & South Team Training Weekend Tier 3 & 4 April 6-8 Tournament Prep Camp, Bear Mountain/Beach Grove, BC Tier 3 & 4 May Future Links Pacific, Bear Mountain, Victoria, BC May TBD Tournament Prep Camp, Highwood GC, High River, AB Tier 2, 3 & 4 May 23 Spring Competition & Opening Conference Tier 1, 2, 3, 4 June 1 3 Future Links Western Highwood GC, High River, AB June TBD Tournament Prep Camp, Sundre/Coyote Creek, Sundre, AB Tier 2, 3 & 4 July 3 6 July 3 5 Alberta Junior & Juvenile Boys, Sundre GC, Sundre, AB Alberta Junior & Juvenile Girls, Coyote Creek GC, Sundre, AB July TBD Tournament Prep Camp, Medicine Hat G&CC, Med. Hat AB Tier 2, 3 & 4 July 9 11 Alberta Ladies Amateur, Willow Park G&CC, Calgary, AB July 15 Mid-Season Sponsor Event, Redtail Landing GC, Nisku, AB Tier 2, 3 & 4 July July 30 Aug 2 July 31 Aug 3 Alberta Mens Amateur, Redtail Landing GC, Nisku, AB Canadian Juniors Boys Championship, Medicine Hat G&CC, AB Canadian Junior Girls Championship, Beach Grove GC, BC August Development Team Camp Tier 2 September Fall Competition & Closing Conference Tier 1, 2, 3, 4 October Post-Secondary Scholarship seminar & Awards presentation (Release of 2019 plan including winter destination camp) 14

15 FEE STRUCTURE AND PAYMENT SCHEDULE Fees for Alberta Golf Player Support program will be as follows: TIER 1 NEXTGEN LOCAL $ GST TIER 2 DEVELOPMENT PROGRAM $ GST TIER 3 PROVINCIAL TEAM ALBERTA $1,800.00* + GST *Tier 3 players will incur additional travel, meal & accommodation costs of approx. $2, Enter desired Program Fee: Plus 5% GST: Total Due: Payment Terms (select one) 100% on March 15 OR installments as follows: Installments: 25% January 15, 25% March 15, 25% May 15, 25% July 15 All athletes must provide an active credit card with their file. ** NO EXCEPTIONS ** Name on Card: Card Number: Expiry Date: CVV: Alternatively, you may provide payment by cheque (including postdated cheques if applicable) to: ALBERTA GOLF # th Street SE, Calgary, AB T2Z 3R6 15

16 ACKNOWLEDGEMENT I understand that as a member of Alberta Golf s High Performance Program, I am expected to contribute to the growth of the game of golf by volunteering my time at various golf related events (Alberta Golf Events, community events, club events, casinos, etc.) I understand that as a member of Alberta Golf s High Performance Program, I am expected to comply with all conditions as set forth by ALBERTA GOLF. I understand my application will be confirmed as being received by Alberta Golf within 3 days of being submitted and a decision with respect to my eligibility will be returned within 30 days. I understand the following program deadlines: TIER 1 NEXTGEN LOCAL May 9, 2018 TIER 2 DEVELOPMENT PROGRAM April 22, 2018 TIER 3 PROVINCIAL TEAM ALBERTA December 22, 2017 The information requested in this Application Form and provided by the applicant and his or her parents or guardians is collected and used by Alberta Golf to assist it in evaluating, planning developing or administering its Player Support Program - High Performance Program. Likewise, as part of its evaluation, planning, development or administration of its Player Support Program - High Performance Program, Alberta Golf can be required to share some or all of the information provided by the applicant and his or her parents or guardians with other provincial or national golf associations and in certain instances, with international golf organizations. In order to provide the best opportunities in golf to the applicant and to assist Alberta Golf with its growth and success of the Player Support Program - High Performance Program, Alberta golf will share the information with these other golf organizations that its believes is reasonably necessary to advance its purposes. The applicant and his or her parents or guardians hereby agree that the collection, use or disclosure of the personal information supplied in this Application Form by Alberta Golf as described above is reasonable. Applicant Signature: Date: Parent Signature: Date: (required if under 18 years): 16

17 Please submit application forms to: Jennifer Davison Director, Sport Development & High Performance