2025 Ernie Els #GameON Autism Golf Clinic Participant Registration Which regional Golf Challenge event are you attending?(Required) The Mirabel Club - Monday, March 10, 2025 (AZ) The Cape Club of Palm City - Monday, May 5, 2025 (FL) Philadelphia Country Club - Monday, June 2, 2025 (PA) Hamilton Farm Golf Club - Monday, June 9, 2025 (NJ) TPC Sugarloaf - Monday, June 9, 2025 (GA) Chicago Highlands Club -Monday, July 14, 2025 (IL) Chambers Bay – Monday, July 28, 2025 (WA) The Club at Golden Valley - Monday, August 4, 2025 (MN) TPC Harding Park - Monday, September 8, 2025 (CA) Omni PGA Frisco: Fields Ranch West- Monday, September 15, 2025 (TX) The Country Club of Waterbury - Monday, September 15, 2025 (CT) TPC Summerlin - Monday, October 6, 2025 (NV) How did you hear about the clinic?(Required) Participant's Name(Required) First Last Participant's Age(Required) Participant's Approximate Height Participant is:(Required) Right Handed Left Handed Participant's golf skill level:(Required) First Day Beginner Intermediate Advanced Participant communicates:(Required) Verbally With pictures With a device Sign language Other Participant's receptive language capability:(Required) Full sentences 1-2 words Gestures only Other Participant's expressive language capability:(Required) Full sentences 1-2 words Gestures only Other Will the participant come with a support aid or 1:1 companion?(Required) Yes No Please note any specific behaviors of concern (e.g. elopement, stimming, self-injurious behavior, etc.) so that golf instructors can best be prepared. Please note this is not to exclude anyone but rather to ensure coaches are best prepared with knowledge of participants' needs. Please provide any additional information below. Parent/Guardian's Name(Required) First Last Parent/Guardian's Email(Required) RELEASE, WAIVER OF LIABILITY And ASSUMPTION OF RISK(Required) I agree. I understand that the game of golf involves risks and dangers that may subject me to serious bodily injury, which may ultimately be fatal. The risks and dangers associated with golf may be caused by my own actions or inaction, or by others participating in the activity. All the possible causes and consequences of participation may not be known to me nor readily foreseeable at this time. My signature on this form demonstrates that I believe I understand the nature of golf activities and that I am in good health and in proper physical condition to participate. I further agree and warrant that, if at any time I believe the activity to be unsafe for me, I will immediately discontinue participation. I fully accept and assume all risk and all responsibility for losses, costs, liability, injury, and damages I may incur as a result of my participation in golf activities at the Els Center of Excellence. Knowing that participation in golf activities entails various risks, and in consideration for being permitted to participate, I release the Els for Autism Foundation, its successors, and assigns from any and all costs, claims, actions, and liability that may arise in connection with my participation in their golf programs. I further agree to indemnify and hold harmless the Els for Autism Foundation, its employees, and contractors for any and all claims arising as a result of my participation in golf activities or any activities incidental thereto, wherever, whenever, or however, they may occur. PHOTO/VIDEO/BIOGRAPHICAL/OTHER MEDIA CONSENT AND RELEASE(Required) I consent to these terms. I do not consent to these terms. I do hereby accept this release (the “Release”) in favor of Els for Autism Foundation, a Florida non-profit corporation (“Els for Autism”) and do hereby irrevocably give my permission and grant to Els for Autism the right to: (i) film, record, photograph and collect (collectively, and including any derivative works thereof, the “Recordings”) my and/or my child’s (if applicable) name, image, likeness, and voice (collectively, “My Likeness”) and my biographical information and any oral or written statements, materials, or interviews I have given or will give (collectively, “Biographical Materials”) (ii) edit, copy, use, reproduce, exhibit, publish, distribute, create derivative works, and otherwise use My Likeness and/or Biographical Materials, as they appear or exist in any Recording, in any medium now or future existing (including, without limitation, in print, online or hard copy publications, video, television, internet, film, and any other medium) for educational, philanthropic, public relations, marketing, advertising, fundraising, and/or promotional purposes. I understand and agree that I am granting Els for Autism a perpetual, exclusive, and worldwide license to use and display My Likeness and Biographical Materials in such Recordings without any compensation therefore now or in the future. I further acknowledge and agree that Els for Autism is and will be the sole and exclusive owner of all right, title, and interest in and to any Recording, including all copyrights and other intellectual property rights therein, in perpetuity throughout the world. To the extent all or any part of a Recording does not qualify as, or otherwise fails to be, the intellectual property of Els for Autism, I hereby assign, transfer, and otherwise convey to Els for Autism, irrevocably and in perpetuity, throughout the world, all of my and/or my child’s (as applicable) right, title, and interest in and to any and all Recordings, including all copyright and other intellectual property rights. I do hereby: 1. Represent and warrant that I am at least eighteen (18) years of age, and have full right, power and authority to enter into this Release and grant the rights granted in this Release. By signing this Release I acknowledge that I have completely read and fully understand the terms of this Release and agree to be bound by them; 2. To the fullest extent permitted by applicable law, irrevocably waive all legal and equitable rights relating to all liabilities, claims, damages, and other actions related to or arising from Els for Autism’s exercise of its rights under this Release or its use of any recording in accordance with the terms of this Release; and 3. Forever waive and disclaim any right I might have now or in the future to (A) receive compensation for my participation in the Recordings or any activities related thereto, (B) assert ownership of any Recording, and (C) inspect or approve any finished products, advertising or marketing materials, or other copy of any Recording that may be used by Els for Autism in accordance with this Release. To the extent my minor child is a participant in any Recording, I, the undersigned, hereby execute and deliver this Release, and grant all the rights granted herein with regard to any such Recording, to Els for Autism, in my capacity as my child’s parent or legal guardian.
