2023 SUMMER CAMP REGISTRATION - Agape Black Belt Center

Camper Information

Instructions **Weekly Field Trip Admission and Friday Pizza Party Are Included in the Camp Fee. **Full-Time Camp (7:30 am-6 pm) Fee Includes One Camp T-shirt. **First Time Camper needs to pay a One-time Registration Fee.

Campers Name *

Birthday *

Age *

Allergies *

Parent/Guardian Information

Parent/ Guardian's Name *

Relation *

Cell Phone *

Work Phone (Optional)

Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *

Camp Information

Which Camp? *

No need to pay for camp at this time.We will confirm the date later.Camp #1 - July 10-14Camp #2 - July 17-21Camp #3 - July 24-28Camp #4 - July 31- Augst 04Camp #5 - August 07-11Camp #6 - August 14-18Camp #7 - August 21-25Camp #8 - August 28-Sept 1

Full Camp Fee (7:30AM-6:00PM) *Field Trip Fee, Pizza Party, and Camp T-shirt are included.

Camp Fee (8AM-3PM) *Field Trip Fee and Pizza Party are included.

First Time Camper Registartion Fee $49 *

One-Time Registration Fee.First Time Camper Registration Fee $49Returning Camper $0

Camper T-Shirt *Select Your Child's Camp Shirt Size.

Waiver I hereby voluntarily submit my application for my attendance and participation to Agape Black Belt Center, LLC and hereby assume all responsibilities for any and all damages, injuries or losses I may sustain or incur while attending and participating. I hereby release and waive all claims against the sponsors, promoters, organizers, operators, host, instructors, associations, schools, owners, officers, directors, employees and other participants connected with Agape Black Belt Center, LLC individually or otherwise. I fully understand that in case of injury the only medical treatment provided will be first aid. I understand that I must strictly obey instructors and observe safety rules. I further agree that any photography and video taping of me in connection with Agape Black Belt Center, LLC can be used for publication, promotion, articles, and advertisements without additional consent and without compensation at this time or any other time. I understand that all registration fees are non-refundable.

Yes. I agree to tearms *

Yes

Parent/ Guardian Name *

Camper Information

Parent/Guardian Information

Camp Information

Emergency Contact

Authorized Pickup Person

Verification

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