Day Camp

Published: September 13, 2021

– BOUNCE House, Ice Creams and much more fun with ABBC Students.

Camper Information

Camper Name *

Birthday *

Age *

Allergies *

Parent/Guardian Information

Parent/ Guardian's Name *

Relation *

Cell Phone *

Address *

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

Email *

Emergency Contact Information

Emergency Contact Person's Name *

Relation *

Emergency Contact phone *

Insurance Company Name *

Family Physician Name *

Physician's Phone *

Camp Information

Which Camp? *

Each camper needs to pack their own lunch and snack.03/28/2025 Regular Day Camp : 8AM-3PM $7903/28/2025 Full Day Camp : 7:30AM-6PM $99

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 these terms *

Yes

Parent/ Guardian Name *

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Published: September 13, 2021

Categories: After School, Camp, School Announcement