Name:
Address:
City:
State:	Zip:
E-mail:
Home Phone:
Work Phone:
Cell Phone:
Date of Birth:
Age:	Sex:
How did you hear about LI Golf Academy?

Multi-week or one-week sessions:

Tuition:

$995 one-week session, or

$1895 for any two-week session*

A deposit of $250 is required for registrations made before 5/1/10. All fees due by 6/1/10. All applications received after 6/1/10 must be accompanied by payment in full. LI Golf Academy, LLC will not allow campers to participate before all fees have been paid in full. LI Golf Academy, LLC will accept registrations up until the start of any session where openings exist. Camp credit only for cancellations not made before 30 days of scheduled first day of session. Camp credit only will be issued at the discretion of LI Golf Academy, LLC.

The applicant will provide proof of recent medical exam and has permission to participate in this program. In case of emergency, I grant permission for my child to be given medical treatment as prescribed by a physician or hospital. I agree to hold LI Golf Academy, LLC harmless from any liability, loss, or personal expense arising out of this camp. I give permission for the use of any photos or video involving my child taken at camp for publicity purposes. I have read and agree to abide by the above.

Parent and/or Legal Guardian: