2014 mizzou golf camps registration - Missouri Golf Association
2014 MIZZOU GOLF CAMPS REGISTRATION
CAMPS I & II FEATURES
The Mizzou Golf Camp is a fun way to learn the game of golf. Every player will receive individual and group instruction in all facets of the game. Students will play and practice daily at Mizzou’s home course, The Club at Old Hawthorne, and utilize the new Walsworth Family Golf Center. Our philosophy emphasizes teaching the fundamentals and mechanics of the game of golf. Along the way students will be mentored in golf etiquette, the recruiting process and life skills. Each student will receive a DVD recording of their swing analysis at the conclusion of the camp.
Address: City: State:
Zip:
Email Address: Home Phone: (
)
Birth date:
WHEN
Indemnification by Parent or Guardian of Applicant The undersigned parent or guardian of ________________________, the applicant, for and in further consideration of the Golf Camp accepting said applicant, does hereby release and discharge the Curators of the University of Missouri and its representatives, employees and agents from any and all debts, claims, demands actions, damages, causes of action, judgements or suits of any kind which may arise or be occasioned as a result of the applicant’s participation in the Golf Camp and hereby, agree to have and indemnify and keep harmless the Curators of the University of Missouri, its representatives, employees and agents against any and all liability, claims, judgements or demands for damages arising as a result of any course instruction given the applicant by the Golf Camp.
Name:
Grade Level in School:
CAMP I: June 9-13 CAMP II: June 23-27 Check-in/Registration- Monday, 1 p.m. Check-out/Award Ceremony- Friday, 2 p.m.
School:
CAMP I co-ed: June 9-13 ($995)
ELIGIBILITY
CAMP II co-ed:- June 23-27 ($995)
LOCATION
Registration Fee includes: All related golf fees, individual and group instruction, four nights lodging, meals (Monday dinner through Friday lunch), camp t-shirt and awards.
Players ages 11-18 are eligible for the camps. Enrollment is open to all skill levels. The camps will be held at The Club at Old Hawthorne, located east of Columbia, Mo. Students will be housed in one of the University of Missouri’s newest dorms.
FEES
Please check camp(s) you wish to attend:
Signature of Parent or Guardian Date
Enrollment limited to the first 24 campers registered in each session. Payment: Make check payable to: Mizzou Golf Camp.
_________________________________ Signature of Parent or Guardian Date
$995 per session. A non-refundable $250 deposit is required in order to guarantee a spot in the camp. The remaining balance is due May 25, 2014. If full payment is not received by May 25, 2014, students forfeit their deposit and spot in the camp. Children of University of Missouri faculty and staff will receive an additional $100 discount. A team incentive is also available. Campers who register with a teammate from their high school will receive a $100 discount.
Overnight students ($995)
EQUIPMENT NEEDED
Total Payment (including all discounts): ______________________
• Golf clothes and attire for the length of the camp. Please include collared shirts and Bermuda shorts to wear at the golf course. All clothing, clubs and personal items should be labeled with your name or ID. • Rain gear and umbrella in event of bad weather. • Golf Bag- we highly recommend a light, small carry bag. • Golf Equipment- you should bring your clubs, shoes, golf balls and gloves. • Tennis shoes or an extra pair of street shoes. • Soap, extra towels, pillow and toiletries. • Sunscreen (a must!)
Discounts: Check all that apply MU faculty/staff (-$100) Team Incentive (-$100)
Deposit ($250) (Due with registration form to guarentee spot.) ---------------------------------------------------------------------------------------Mail completed form to: Walsworth Family Golf Center Attn: Mindy Coyle 1901 Old Hawthorne Dr. Columbia, Mo. 65201
Experienced trainers are available at all times. Each camper is covered by health and accident insurance during camp hours. Insurance coverage is secondary to primary insurance. You must fill out the Indemnification and Medical Treatment Authorization forms to complete your registration.
Emergency Contact Name: Relation to camper: Cell Phone: Please list any pre-existing medical conditions: Are you or your dependent entitled to benefits under Employer Union, Group Plan, Group Blue Cross, Blue Shield, Medicare, Medicade or any other governmental program?
S
M
L
XL
FOR MORE INFORMATION:
SAFETY AND INSURANCE
____________
Yes
No
Person carrying other insurance coverage and relationship to
T-shirt size (adult sizes):
Contact the Mizzou Golf Office (573) 882-1672 or [email protected]
Medical Treatment Authorization I/We being the parents and/or legal guardians of the applicant authorize the University of Missouri and its agents permission to request emergency medical treatment or care as necessary to ensure the well-being of our dependent. Further, I claim that the registrant has had a physical examination in the past year as was found fit for all physical endeavors.
applicant: Employer or Sponsoring Organization:
Roommate Request 1st choice_____________________________________ 2nd choice____________________________________
Insurance Company:
*An MU booster may not pay camp admission fees unless the camper is an immediate family member.
Addition Insurance Information:
Policy #: Group #:
CAMP STAFF MARK LEROUX
Head Men’s Coach
JUDD EASTERLING Assistant Men’s Coach • • • •
First year at Mizzou. Two-time All-American golfer at Wichita State. Played in three NCCC National Championships Member of the Missouri Valley All-Centennial Golf team in 2007.
STEPHANIE PRIESMEYER Head Women’s Coach
• 13th year at Mizzou. • Has led Missouri to nine tournament titles. • Was named the 2004 Big 12 Women’s Golf Coach of the Year. • Selected the 2005 Central Region Coach of the Year.
Walsworth Family Golf Center 1901 Old Hawthorne Dr. Columbia, Mo. 65201
• 10th year at Mizzou. • Led Missouri to NCAA Championships in 2005. • Seven NCAA Regional appearances. • Two All-American Golfers. • Nine Academic All-Americans.
2014 Golf camps
MINDY COYLE
Assistant Women’s Coach
• Eighth year at Mizzou • As a player, led Missouri to the NCAA Championships in 2005. • Finished in second place at the 2003 Big 12 Championships.
JOHN UTLEY
Head Men’s and Women’s Golf Coach --Columbia College
• Third year at Columbia College. • Played professionally for 10 years. • Has worked as an instructor since 2000, working with noted golf teachers Jim Hardy, E.J. Pfister and his brother, Stan Utley.
camp I camp II co-ed June 9-13
co-ed June 23-27
CAMPS I & II FEATURES
The Mizzou Golf Camp is a fun way to learn the game of golf. Every player will receive individual and group instruction in all facets of the game. Students will play and practice daily at Mizzou’s home course, The Club at Old Hawthorne, and utilize the new Walsworth Family Golf Center. Our philosophy emphasizes teaching the fundamentals and mechanics of the game of golf. Along the way students will be mentored in golf etiquette, the recruiting process and life skills. Each student will receive a DVD recording of their swing analysis at the conclusion of the camp.
Address: City: State:
Zip:
Email Address: Home Phone: (
)
Birth date:
WHEN
Indemnification by Parent or Guardian of Applicant The undersigned parent or guardian of ________________________, the applicant, for and in further consideration of the Golf Camp accepting said applicant, does hereby release and discharge the Curators of the University of Missouri and its representatives, employees and agents from any and all debts, claims, demands actions, damages, causes of action, judgements or suits of any kind which may arise or be occasioned as a result of the applicant’s participation in the Golf Camp and hereby, agree to have and indemnify and keep harmless the Curators of the University of Missouri, its representatives, employees and agents against any and all liability, claims, judgements or demands for damages arising as a result of any course instruction given the applicant by the Golf Camp.
Name:
Grade Level in School:
CAMP I: June 9-13 CAMP II: June 23-27 Check-in/Registration- Monday, 1 p.m. Check-out/Award Ceremony- Friday, 2 p.m.
School:
CAMP I co-ed: June 9-13 ($995)
ELIGIBILITY
CAMP II co-ed:- June 23-27 ($995)
LOCATION
Registration Fee includes: All related golf fees, individual and group instruction, four nights lodging, meals (Monday dinner through Friday lunch), camp t-shirt and awards.
Players ages 11-18 are eligible for the camps. Enrollment is open to all skill levels. The camps will be held at The Club at Old Hawthorne, located east of Columbia, Mo. Students will be housed in one of the University of Missouri’s newest dorms.
FEES
Please check camp(s) you wish to attend:
Signature of Parent or Guardian Date
Enrollment limited to the first 24 campers registered in each session. Payment: Make check payable to: Mizzou Golf Camp.
_________________________________ Signature of Parent or Guardian Date
$995 per session. A non-refundable $250 deposit is required in order to guarantee a spot in the camp. The remaining balance is due May 25, 2014. If full payment is not received by May 25, 2014, students forfeit their deposit and spot in the camp. Children of University of Missouri faculty and staff will receive an additional $100 discount. A team incentive is also available. Campers who register with a teammate from their high school will receive a $100 discount.
Overnight students ($995)
EQUIPMENT NEEDED
Total Payment (including all discounts): ______________________
• Golf clothes and attire for the length of the camp. Please include collared shirts and Bermuda shorts to wear at the golf course. All clothing, clubs and personal items should be labeled with your name or ID. • Rain gear and umbrella in event of bad weather. • Golf Bag- we highly recommend a light, small carry bag. • Golf Equipment- you should bring your clubs, shoes, golf balls and gloves. • Tennis shoes or an extra pair of street shoes. • Soap, extra towels, pillow and toiletries. • Sunscreen (a must!)
Discounts: Check all that apply MU faculty/staff (-$100) Team Incentive (-$100)
Deposit ($250) (Due with registration form to guarentee spot.) ---------------------------------------------------------------------------------------Mail completed form to: Walsworth Family Golf Center Attn: Mindy Coyle 1901 Old Hawthorne Dr. Columbia, Mo. 65201
Experienced trainers are available at all times. Each camper is covered by health and accident insurance during camp hours. Insurance coverage is secondary to primary insurance. You must fill out the Indemnification and Medical Treatment Authorization forms to complete your registration.
Emergency Contact Name: Relation to camper: Cell Phone: Please list any pre-existing medical conditions: Are you or your dependent entitled to benefits under Employer Union, Group Plan, Group Blue Cross, Blue Shield, Medicare, Medicade or any other governmental program?
S
M
L
XL
FOR MORE INFORMATION:
SAFETY AND INSURANCE
____________
Yes
No
Person carrying other insurance coverage and relationship to
T-shirt size (adult sizes):
Contact the Mizzou Golf Office (573) 882-1672 or [email protected]
Medical Treatment Authorization I/We being the parents and/or legal guardians of the applicant authorize the University of Missouri and its agents permission to request emergency medical treatment or care as necessary to ensure the well-being of our dependent. Further, I claim that the registrant has had a physical examination in the past year as was found fit for all physical endeavors.
applicant: Employer or Sponsoring Organization:
Roommate Request 1st choice_____________________________________ 2nd choice____________________________________
Insurance Company:
*An MU booster may not pay camp admission fees unless the camper is an immediate family member.
Addition Insurance Information:
Policy #: Group #:
CAMP STAFF MARK LEROUX
Head Men’s Coach
JUDD EASTERLING Assistant Men’s Coach • • • •
First year at Mizzou. Two-time All-American golfer at Wichita State. Played in three NCCC National Championships Member of the Missouri Valley All-Centennial Golf team in 2007.
STEPHANIE PRIESMEYER Head Women’s Coach
• 13th year at Mizzou. • Has led Missouri to nine tournament titles. • Was named the 2004 Big 12 Women’s Golf Coach of the Year. • Selected the 2005 Central Region Coach of the Year.
Walsworth Family Golf Center 1901 Old Hawthorne Dr. Columbia, Mo. 65201
• 10th year at Mizzou. • Led Missouri to NCAA Championships in 2005. • Seven NCAA Regional appearances. • Two All-American Golfers. • Nine Academic All-Americans.
2014 Golf camps
MINDY COYLE
Assistant Women’s Coach
• Eighth year at Mizzou • As a player, led Missouri to the NCAA Championships in 2005. • Finished in second place at the 2003 Big 12 Championships.
JOHN UTLEY
Head Men’s and Women’s Golf Coach --Columbia College
• Third year at Columbia College. • Played professionally for 10 years. • Has worked as an instructor since 2000, working with noted golf teachers Jim Hardy, E.J. Pfister and his brother, Stan Utley.
camp I camp II co-ed June 9-13
co-ed June 23-27
