Summer Camp Registration Form

Summer 2017 Camps for Kids

Pacific Northwest Martial Arts Academy (PNMAA LLC) Registration & Liability Release Form

 

Mother (First/Last) ______________________Father (First/Last)________________________________

(Complete Mother/Father info if student is less than 18 years of age)

Mailing Address __________________________­­_____ City ____________ State ____ Zip ____________

Home Phone _____________ Mother’s Cell Phone ______________ Father’s Cell Phone_____________

Email Address ___________________ Emergency Contact___________________ Phone _____________

Student’s Name (First/Last) __________________________ Date of birth ___________ Gender:   M     F

T-Shirt Size (Circle One):  Child Small           Child Medium      Child Large           Child Extra Large               

                                             Adult Small          Adult Medium     Adult Large          Adult Extra Large

2017 Summer Camps (Circle which camp/camps your child will be attending. Ages are as of camp dates.):

               Wushu/Kung Fu Camp:                    July 10-14 (ages 5-9)            and/or       July 31-August 4 (ages 8-16)

               Parkour Camp:                                  July 17-21 (ages 8-16)

               Girl Power Camp (girls only!):        June 19-June 23 (ages 4-12)

               PNMAA Deluxe Camp:                     June 26-June 30 (ages 8-16)   and/or    August 14-August 18 (ages 5-9)

Camp Pricing (All Camp Pricing Includes Washington State Sales Tax)

               One Camp only:                 $195 per child/per camp                

               Two Camps:                        $175 per child/per camp

               Three or More Camps:      $150 per child/per camp

** Early Bird Pricing Discount!         Register and pay before May 31, 2017, and save $30 off each camp pricing tier!

** PNMAA Member Discount!      PNMAA Members receive an additional $20 off of each camp pricing tier! (Note: a PNMAA “Member” is one who is registered and currently taking regularly offered PNMAA classes as of May 15th, 2017. Early Bird Pricing Discounts also apply to PNMAA Members if registered & paid by May 31st, 2017.)

Important Camp Information

  • A minimum of 10 kids per camp/time are needed. If the camp you signed up for does not fill up, you will be contacted and will have the option of selecting another camp or receiving a full refund.
  • Camps must be paid in full one week prior to camp start date.
  • Summer Camp pricing is excluded from normal PNMAA class tuition discounts.
  • Parent volunteers are welcomed, especially at lunch time when we will be leaving the studio for a nearby park (for eating and open air activities).
  • Please provide a daily sack lunch for your child and a water bottle.
  • Please make sure your child wears a good pair of tennis shoes for walking to the park (no flip flops, bare feet, Crocs, ballet shoes, etc).

 

Payment Information:  We currently accept cash, checks and credit/debit card payments payable to PNMAA.  A $25 returned check charge will be added for any checks returned by the bank.  Payment, in full, is due 1 week prior to camp start date *OR* May 31st, 2017, for Early Bird Pricing Discount.

**** TURN OVER FORM TO FINISH REGISTRATION PROCESS ****

LIABILITY, MEDICAL & CONSENT RELEASE / PAYMENT AGREEMENT, CONTINUED

Release of Liability / Parent Consent

As the legal parent or guardian, I release and hold harmless Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners, operators, employees and camp volunteers from any and all liability, claims, demands, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises under the control and supervision of Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners and operators or in route to and from any said premises, including walks to and from nearby public parks.

Medical Emergence Release

The undersigned gives permission to Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners, employees and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian.  I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical health and mental health.

Allergies/Health Restrictions: ___________________________________________________________________

I request that our doctor ________________________ be called and that my child be transported to

______________________ hospital.  Please include doctor’s phone number ____________________

Printed Name of Parent/Guardian ___________________________________ Date ______________

Parent Signature ____________________________________________________________________

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