Quia Home Home FAQ About Log in Subscribe now 30-day free trial

2008 Chamberlain Golf Camp Registration

REGISTRATION FOR THE 2008 CAMP YEAR IS NOW OFFICIALLY CLOSED. PLEASE CONTACT BRUCE CHAMBERLAIN AT 973-634-8379 FOR YOUR GOLF INSTRUCTION NEEDS. SEE YOU IN 2009!!!

Complete this form and press the SUBMIT button. You will receive an e-mail confirmation within 2-3 days.

Your registration is not considered complete until PAYMENT and the WAIVER FORM are received. The WAIVER FORM is available on-line and may be submitted together with payment. Payment may also be made separately via an on-line banking account. Sorry, we do not accept credit/debit cards.


Please submit a separate registration for sibling campers and/or multiple camp weeks.

Please note: After submitting this form, you may be directed to the QUIA.com website. You can simply CLOSE YOUR BROWSER WINDOW at that time.

Thank you!


A red asterisk (*) indicates required questions.

  1. Camper's Name (Last, First)*


  1. Birth Date (mm/dd/yyyy format)*


  1. School Grade Level in September 2008:*
    K-2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12


  1. Street Address*


  1. City, ST ZIP*


  1. Primary parent/guardian name (Last, First):*


  1. Parent/guardian e-mail id:*


  1. RE-TYPE parent/guardian e-mail id:*


  1. Home phone number:*


  1. Parent/guardian cell phone number:


  1. Secondary/emergency contact name (can be spouse, relative, friend):


  1. Camp level (see the website for program descriptions):*
    PeeWee ($175/week Mon-Thurs 8am-10am)
    Par-4 ($295/week Mon-Thurs 8am - 12 noon)
    Par-5 ($365/week Mon-Fri 8am - 12 noon)
    Eagle ($450/week Mon-Fri 8am - 1pm)


  1. Secondary/emergency contact phone (preferably cell):


  1. First choice of camp week beginning:*
    Mon, June 23rd
    Mon, June 30th UNAVAILABLE
    Mon, July 7th
    Mon, July 14th
    Mon, July 21st
    Mon, July 28th UNAVAILABLE
    Mon, August 4th
    Mon, August 11th


  1. Second (backup) choice of camp week beginning:
    Mon, June 23rd
    Mon, June 30th UNAVAILABLE
    Mon, July 7th
    Mon, July 14th
    Mon, July 21st
    Mon, July 28th UNAVAILABLE
    Mon, August 4th
    Mon, August 11th


  1. Payment/registration options:

    (Note: When you are done with this form, click on the [submit answers] button below. You may be directed to the Quia.com website... you can simply close the browser window at that time.)

    You may select one of the following payment/registration options:


    *
    I will print, sign and mail the registration/waiver form and include a check payable to "Chamberlain Golf."
    I will print, sign and mail the registration/waiver form and make a separate payment from my on-line banking checkbook payable to "Chamberlain Golf."