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Registration. Please circle the week/s your child will be attending: July 8-12 July 15-19. Camp Tonchu 2013. 1 st Childs Name ____________________________ Age______ Gender M___ F ___ Medical Conditions/Food Allergies ________________________________________

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camp tonchu 2013

Registration

Please circle the week/s your child will be attending:

July 8-12 July 15-19

Camp Tonchu 2013

1st Childs Name ____________________________ Age______ Gender M___ F ___

Medical Conditions/Food Allergies ________________________________________

2nd Childs Name ____________________________ Age______ Gender M___ F ___

Medical Conditions/Food Allergies ________________________________________

3rd Childs Name ____________________________ Age______ Gender M___ F ___

Medical Conditions/Food Allergies ________________________________________

Home Address _________________________________________ Apt # _________

City ____________________________ County ___________________ Zip _______

Home # _______________ Cell # ___________________ Work # _______________

2013 Camp Tonchu Registration

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Registration

Parent/Guardian Information

Father/Guardian Name _________________________ Email ___________________

Place of Employment __________________________ Daytime # ________________

Address (if different than child) ___________________________________________

Mother/Guardian Name _________________________ Email __________________

Place of Employment __________________________ Daytime # ________________

Address (if different than child) ___________________________________________

Camp Tonchu 2013

Children will be released only to the person(s) authorized, in writing, by the custodial parent(s) or legal guardian(s).

The following people are authorized to remove my child(ren) from the facility:

Name _______________________ Relationship _________________

Name _______________________ Relationship _________________

Name _______________________ Relationship _________________

2013 Camp Tonchu Registration

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Registration

Medical Information/Treatment Release

Please let us know of any medical/emotional conditions that will help us take the best care of your child possible.

_______________________________________________________

_______________________________________________________

_______________________________________________________

Physician __________________ Physician # ___________________

THIS AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT MUST BE COMPLETED BEFORE PARTICIPATION IN ACTIVITIES. TREATEMENT FOR INJURY WILL BE BASED ON INFORMATION PROVIDED HEREIN.

In consideration of your acceptance of this registration, I do hereby, for myself, my heirs, executors and administrators waive, release and forever discharge any and all rights and claims for damages I or my family may have or which may accrue to me or my family against Tonchu Martial Arts Academy/Camp Tonchu and all members or its representatives. I hereby consent to have associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I also agree to save hold harmless and indemnify each and all parties herein referred to above from all liability, loss, cost, claim or damage whatsoever, including death or damage to property. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily. I hereby state my children are physically fit to take the prescribed course on our free will. I understand that enrollment fees and camp fees are nonrefundable. I also understand that if my tuition is not paid by 1:00 PM on Tuesday that my child will not be allowed to participate and any payments received after closing on Monday will incur a $15 late fee. I hereby grant permission for my child/children listed on page 1 to ride with authorized Camp Tonchu staff for field trips.

BY SIGNING THIS FORM I AM AGREEING TO ALL TERMS AND CONDITIONS.

Parent/Guardian Signature _______________________________________ Date _________

Camp Tonchu 2013

2013 Camp Tonchu Registration

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Registration

Payment/Fees/Extras

Camp Tonchu 2013

There is a $50 Registration Fee ($30 for any additional children).

**Tonchu Martial Arts Academy Students Registration is $30 for all children applying

The fee for the camp is $250 for one week or $400 for two weeks.

Camp is from 9a-3p Monday – Friday. There is a special Martial Arts Class offered each day from 3:15-4p for an additional $75/week. You must register for this class in advance of the class.

I want to enroll my child in the 3:15-4pm Martial Arts Class

Yes No

Does your child require a car/booster seat? __________________

**You will need to provide your child’s car/booster seat each day of field trips, Monday – Thursday (weather permitting). If your child does not have his/her car/booster seat, they will not be permitted to go on that days field trip. Your child’s safety is our greatest concern!

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Registration

Parent Participation

If you would like to attend one or more of the field trips to act as chaperone, please indicate here. If you have small children you would like to bring along with you, that is acceptable, you and your child will be paid for. List of specific trips will be listed within two weeks of the camp. Please let us know at least one week in advance so that we may have reservations for everyone.

Camp Tonchu 2013

Yes, I would like to help chaperone Camp Tonchu field trips

I will not be able to chaperone field trips

2013 Camp Tonchu Registration