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Registration Form
Emerson Summer GOLF Camp Program 2015
Child’s Name _____________________________________Age_______
Parent’s Name ______________________________________________
Address ____________________________________________________
City, State, Zip _____________________________________________
Home Phone _____________________ Cell Phone ________________
Parent E-mail ______________________________________________
I am registering my child for GOLF CAMP: (Tuesday through Friday 3pm-7pm)
___Week
___Week
___Week
___Week
1
2
3
4
(July
(July
(July
(July
7-10)
14-17)
21-24)
28-31)
___ Week 5 (August 4-7)
___ Week 6 (August 11-14)
___ Week 7 (August 18-21)
___ Week 8 (August 25-28)
Rates: $120 per day OR $399 per week
Early Registration special: Sign up by 5/15/15 to receive a 10% discount
I authorize Kenny Jung Golf Camp to photograph and/or videotape my registered junior for use in
publications and/or website.
I allow the registered junior above, to participate in a Kenny Jung Golf Camp. I will not hold Kenny
Jung Golf or any of the involved instructors liable for any accidents or injuries that might occur during
camp. I will take responsibility for my child actions.
Parent’s Signature:______________________________$ _____________Enclosed
Emergency Contact: ____________________________Phone:________________
Make up class is available only during the summer session (7/7-8/28/15)
Send registration & payment to:
Kenny Jung Golf at 21 Golf Range 1 Route 46 West, Palisades Park NJ 07650
T 201 887 7705