Day Camp Registration Form

• Children ages 5 & up are welcome at our camps. 

  They don't have to be a student to participate!

   
  

  Our day camps are offered from 7:30am to 6:00pm

   
  

  They will need a sack lunch, a snack & their TKD belt.

   
  

  **This form is to collect information ONLY**

  You must go back to the previous page and make a payment to complete your registration.
  
• Participant's First Name

  Participant's Last Name
  

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• Participant's Birthday
  

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• Mom/Guardian First Name

  Mom/Guardian Last Name
  

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• Mom/Guardian Mobile Phone
  

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• Mom/Guardian Email Address
  

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• Dad/Guardian First Name

  Dad/Guardian Last Name
  

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• Father/Guardian Mobile Phone
  

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• Father/Guardian Email Address
  

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• Home Phone (leave blank if none)
  

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• Please list any medical concerns that we should be aware of (if none, leave blank).
  

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• Emergency Contacts/Permission to Pick Up:  Please list the names and phone numbers of anyone OTHER THAN A PARENT who is allowed to pick your child up from camp or should be contacted in an emergency.  In the event of an emergency, we will ALWAYS attempt to contact the parents first.

  
• Emergency Contact Name 1

  Emergency Contact Phone 1
  

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  Make Required
• Emergency Contact Name 2

  Emergency Contact Phone 2
  

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• Photograph Waiver

  I give Midtown Taekwondo the right to publish pictures of my child/children and/or myself. I understand that these pictures may be printed, placed on the Midtown Taekwondo website, or incorporated into promotional material such as brochures and videos. I also understand the circulation of the materials could be worldwide and that there will be no compensations to me for this use.

  
• Initial

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• Medical Release & Liability Waiver

  I authorize Midtown Taekwondo representatives to obtain medical treatment for my child in case of serious illness or injury and agree to pay for such treatment.  I have noted above any special health-related conditions or allergies regarding my child.
  

  In consideration for my child's attendance and participation in the martial arts training offered by Midtown Taekwondo I, the parent, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve the school, it's management, assigned staff and fellow students from any liability resulting from loss, whether personal belongings or bodily injury. I also hereby state, that myself or my child is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for an agreed upon fee.  I understand that every precaution will be taken to ensure the safety of my child. 

  I also acknowledge that participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza and COVID-19.  I knowingly and freely assume all such risks, both known and unknown even if arising from the negligence of the releasees or others and assume full responsibility for my participation.  I agree to comply with all stated conditions for participation in regards to protection against infectious diseases.  I release and hold harmless Midtown Taekwondo staff, employees, and participants.  I have read these provisions and understand my personal responsibility for adhering to the rules and regulations for protecting against communicable diseases.

   

  

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• How did you hear about our day camps?

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•  

  **This form is to collect information ONLY**

  You must go back to the previous page and make a payment to complete your registration.
  

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