Name:

Address:

City:

State: Zip:

Email Address:

Home Phone: ( )

Birth date: Grade Level in School:

School:

Please check camp(s) you wish to attend: CAMP I co-ed: June 9-13 ($995)

CAMP II co-ed:- June 23-27 ($995)

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.

Enrollment limited to the first 24 campers registered in each session.

Payment: Make check payable to: Mizzou Golf Camp.Overnight students ($995)

Discounts: Check all that applyMU faculty/staff (-$100) Team Incentive (-$100)

Total Payment (including all discounts): ______________________

Deposit ($250) (Due with registration form to guarentee spot.)

----------------------------------------------------------------------------------------Mail completed form to:

Walsworth Family Golf CenterAttn: Mindy Coyle

1901 Old Hawthorne Dr.Columbia, Mo. 65201

T-shirt size (adult sizes): S M L XL

Roommate Request1st choice_____________________________________2nd choice____________________________________

*An MU booster may not pay camp admission fees unless the camper is an immediate family member.

Indemnification by Parent or Guardian of ApplicantThe 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.

Signature of Parent or Guardian Date

Medical Treatment AuthorizationI/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 de-pendent. Further, I claim that the registrant has had a physical examination in the past year as was found fit for all physical endeavors.

_________________________________ ____________Signature of Parent or Guardian Date

Emergency ContactName: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?

Yes No

Person carrying other insurance coverage and relationship to

applicant:

Employer or Sponsoring Organization:

Insurance Company:

Policy #:

Group #:

Addition Insurance Information:

2014 MIZZOU GOLF CAMPS REGISTRATION

FEATURESThe 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.

WHENCAMP I: June 9-13CAMP II: June 23-27Check-in/Registration- Monday, 1 p.m. Check-out/Award Ceremony- Friday, 2 p.m.

ELIGIBILITYPlayers ages 11-18 are eligible for the camps. Enrollment is open to all skill levels.

LOCATIONThe 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$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.

EQUIPMENT NEEDED• 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!)

CAMPS I & II

SAFETY AND INSURANCEExperienced 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.

FOR MORE INFORMATION:Contact the Mizzou Golf Office

(573) 882-1672or coylemd@missouri.edu

Walsw

orth Fam

ily Golf C

enter1901 O

ld Haw

thorne Dr.

Colum

bia, Mo. 65201

2014

Golf camps

MARK LEROUX Head Men’s Coach• 10thyearatMizzou.• LedMissouritoNCAAChampionshipsin2005.• SevenNCAARegionalappearances.•TwoAll-AmericanGolfers.• NineAcademicAll-Americans.

STEPHANIE PRIESMEYERHead Women’s Coach• 13thyearatMizzou.• HasledMissouritoninetournamenttitles.• Wasnamedthe2004Big12Women’sGolfCoachoftheYear.

• Selectedthe2005CentralRegionCoachoftheYear.

JOHN UTLEYHead Men’s and Women’s Golf Coach --Columbia College• ThirdyearatColumbiaCollege.• Playedprofessionallyfor10years.• Hasworkedasaninstructorsince2000,workingwithnotedgolfteachersJimHardy,E.J.Pfisterandhisbrother,StanUtley.

JUDD EASTERLINGAssistant Men’s Coach• FirstyearatMizzou.• Two-timeAll-AmericangolferatWichitaState.• PlayedinthreeNCCCNationalChampionships• MemberoftheMissouriValleyAll-CentennialGolfteamin2007.

MINDY COYLEAssistant Women’s Coach• EighthyearatMizzou• Asaplayer,ledMissouritotheNCAAChampionshipsin2005.

• Finishedinsecondplaceatthe2003Big12Championships.

CAMP STAFF

camp Ico-ed

June 9-13

camp IIco-ed

June 23-27