2025 Summer Camp Registration

Published: January 8, 2024

Camper Information
Instructions Weekly Field Trip Admission ($30) and Friday Pizza Party($15) Are Included in the Camp 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
Full Camp Fee (7:30AM-6:00PM) *For Regular Camp, Select "NONE" in the section.
Camp Fee (8AM-3PM) *If you are choosing FULL CAMP, Select the "NONE"
Non-member Registration Fee $49 *
One Time Registration Fee Includes 1 Camper's T-Shirt ($25 Value)First Time Camper Registration Fee $49Returning Camper $0
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 *
Emergency Contact
Family Dr. Name *
Family Dr. Phone *
Authorized Pickup Person
*Authorized Pickup Person's Name & Phone - 1
Authorized Pickup Person's Name & Phone - 2
Authorized Pickup Person's Name & Phone - 3
Select Week(s)
Camp #1 7/07/25-7/11/25Camp #2 7/14/25-7/18/25Camp #3 7/21/25-7/25/25Camp #4 8/04/25-8/08/25Camp #5 8/11/25-8/15/25Camp #6 8/18/25-8/22/25

Verification
Please enter any two digits *Example: 12
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Published: January 8, 2024

Categories: Camp, School Announcement