Chamberlain Junior Golf Camps

2008 Registration/Waiver Form

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If you have registered on-line (recommended), just print this form and fill-in the camper name with your name and signature on the waiver line below.  For mail registration, please print this form and complete all information below, including parent/guardian signature.
Include a check payable to "CHAMBERLAIN GOLF"
CHAMBERLAIN GOLF
39 South Glen Road
Kinnelon, NJ 07405
973-634-8379
Camp Options:
q PeeWee  $175 (4-day) q Par-5  $365 (5-day)
q Par-4  $295      (4-day) q Eagle  $450 (5-day)
Camp Start Date: _______________ 2nd Choice _______________
   
Camper
Address
City                                                                                        State                         Zip
E-mail
Home phone                                                                         Cell
Birth date                                                                              School Grade Level in Sept 2008

I, the undersigned parent or guardian of _________________________ do hereby agree to forever refrain from making claim or bringing suit against the Glenwild Greens Golf Course (GG), Chamberlain Golf (CG) or any of their agents, servants, or employees and do further release and hold harmless GG and CG or any of their agents, servants, or employees on account of any and all claims, demands, damages, costs, loss of services, expenses, pain and suffering or personal injury arising out of any act or omission whether negligent or not while the above named minor is participating in any activity sponsored by GG or CG.
________________________________________________      _______________________________________________
print parent/guardian name                                                    parent/guardian signature