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 ____________________________________________________________________