Camp_Reg

Check All That Apply
*

June 12 - June 16 ( Full )
June 19 - June 23 ( 1spot)
June 25 - June 30 ( 1spot )
July 10 - July 14 ( Full )
July 17 - July 21 ( 1spot )
July 24 - July 28 ( 1spot )
July 31 - August 4
August 7 - August 11
August 14 - August 18
August 21 - August 25
Select a Time
*

From 9am to 2pm
From 7:30am to 6pm
Student Name -1
*
Birth date: (MM/DD/YY)
*
Gender
*
Student Name -2
Birth date: (MM/DD/YY)
Gender
Student Name -3
Birth date: (MM/DD/YY)
Gender
Parent/Guardian’s Name
*
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Phone Number
*
Email Address
*
THE FOLLOWING IS REQUIRED TO BE ATTACHED TO THIS FORM (Parent to check box indicating task is complete)
*

I have read, understood, and agreed to the Liability Waiver form. The above information is true to the best of my knowledge.
EMERGENCY CONTACT NAME
*
EMERGENCY CONTACT Phone Number
*
Does the Participant take Medication

YES
NO
If YES, name the medication, dosage, times given and doctor’s name and contact number in the space provided below.
Full Name
The following people are authorized to pick up your child from our facility. All identified persons MUST present a photo ID before picking up your child. Please identify all persons authorized for pick up
Date
*

EMERGENCY CONTACT

When you press the submit button, we will send you an electric invoice.

You need to stop by our studio or use the link to pay for the whole payment within 7 days. If not, we cannot hold a spot for your child.

(The summer camp does not include a Taekwondo class)

Thank you.

EMERGENCY CONTACT

Payment