Summer Camp 2021 Registration Form

2023 Summer Camp Enrollment Form
Summer Camp is FULL -- we are accepting "waiting list" registrations but can not promise there will be a spot.*

Acknowledge my student will be placed on a waiting list for Summer Camp
Student Information
Student Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student Birthdate*

MonthDayYear
Gender*

FemaleMale
Student's School*

Live OakEnglandSommerPond SpringsLaurel MountainOther
School Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Parent/Guardian*

First NameLast Name
Primary Phone*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
E-mail*
Enrollment Authority

I have legal authority to enroll this student in the Aim and Focus Karate Summer Camp Program. I accept responsibility for this enrollment. This parent/guardian is automatically authorized for pickup.
Enrollment Authority*

Approved
Secondary Parent/Guardian Information

(secondary not required)
Secondary Parent/Guardian

First NameLast Name
Secondary E-mail
Secondary Primary Phone

Area CodePhone Number
Secondary Alternate Phone

Area CodePhone Number
Authorized for pickup*

Approved
Emergency Contact / Pickup Information
At least one Emergency Contact person (NOT a parent or guardian already listed) must be entered. This will be used if we can NOT reach the parent(s) / guardian(s) listed above.
Emergency Contact Name*

First NameLast Name
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Phone Number*

Area CodePhone Number
Relationship*
Additional Names & Numbers may be provided in the box
The following additional individuals are authorized to pickup the student (optional)
Authorized Pickup

First NameLast Name
Authorized Pickup

First NameLast Name
Additional Names may be listed in the box
Medical Information
Authorization for Emergency Medical Treatment

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the staff of Aim and Focus Karate to seek emergency medical treatment.
Medical Treatment*

Approved
Please list any special medical conditions, previous serious injuries or regular medications (type NONE if applicable)*
None
Doctor or Urgent Treatment Center Information

In the event of a medical emergency when parents / guardians can not be reached, we must have access to medical history for the student in order to provide access to this information for EMS.
Doctor or Emergency Facility Name*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Immunizations & Vision and Hearing Screenings
The student's immunization record is on file at the public/private school the student attends. All immunizations are current. All necessary Vision and Hearing Screenings as required by the Special Senses and Communication Disorders Act are current and on file at the students school.
Immunizations & Vision and Hearing Screenings*

Validated
Weekly Enrollment
Week selection and enrollment

Students are enrolled on a "per week" basis. Please select the weeks your student(s) will be attending.

For new students to Aim and Focus Karate, we ask that the students attend at least 3 weeks of camp (they do NOT have to be consecutive). This helps insure the student has a great experience in the martial art classes.

By selecting any given week you are approving your student's participation in scheduled activities. This includes all planned Field Trips.

Please notify the Director in writing prior to an activity that your student can not participate in.
Available Weeks*

Week #1 (May 30th)Week #2 (June 5th)Week #3 (June 12th)Week #4 (June 19th)Week #5 (June 26th)Week #6 (July 3rd) -- CLOSED 07/04Week #7 (July 10th)Week #8 (July 17th)Week #9 (July 24th)Week #10 (July 31st)Week #11 (August 7th)
Registration Fee
Registration Fee

There is a $50 non-refundable Registration Fee required before your enrollment will be accepted. Registration fee applies to current and new students.

Please indicate your payment preference below.
Registration Fee

Charge credit card on file (current student)Payment will be delivered to the karate school
Weekly Pricing
Current Students: $200/Week

New Students: $220/Week

Siblings: $35/week discount

Cancelation fee: $35/Week (must provide 2 week notice to avoid fee)
Summer Camp Operational Policies Document
T-Shirts will be on sale during the Summer months. Students will wear a lose fitting mesh jersey (like flag football jersey) on all field trips. The jerseys will be laundered after every use.

I have read and acknowledge the content of the "Summer Camp Operational Policy Document". This document is available on the Aim and Focus Karate web site (www.aimandfocus.com). This includes review of our "Discipline and Guidance Policy" as well as the "Gang Free Zones" section.
Browse the Operational Policies Document?

YesNo
Operational Policy Document*

Approved
Waiver & Financial Obligations
Transportation

I am giving permission for the student listed on this form to be transported to/from Summer Camp activities.
Transportation*

Approved
Liability Waiver

I am giving permission for the student listed on this form to participate in the Aim and Focus Karate Summer Camp Program. I realize the staff and instructors will do everything in their power to protect my child when in their care. I will not hold them responsible and waive all claims against the Aim and Focus Karate School Inc. for any accidents that may occur when the student is in their care. I also acknowledge that Aim and Focus Karate Inc. does not provide medical insurance coverage for accidents.
Liability Waiver*

Approved
Financial Obligations

I agree to all financial obligations related to my student's attendance in the Aim and Focus Summer Camp. These obligations are defined in the Summer Camp Operational Policies Document (available on the Aim and Focus Karate web site). I have reviewed this document and agree to the obligations.

Forms are available at the front desk to provide credit card and ACH transfer information.
Financial Obligations*

Approved
Options*

Credit CardACH / EFT Bank TransferCash / Check
Final Step !!!!
Final Enrollment Step

To finalize your enrollment, you must physically sign (ink) the "Approved" enrollment form and a release of liability waiver paper form. This can be done the first week your student attends camp (does NOT have to be done prior to that).

The final step to complete the enrollment is payment of the Registration Fee ($50). This can be done by calling the school to provide credit card information or leaving a payment with the office manager at the front desk.
Should be Empty:

2023 Summer Camp Enrollment Form

Student Information

Parent/Guardian Information

Secondary Parent/Guardian Information

Emergency Contact / Pickup Information

Medical Information

Doctor or Urgent Treatment Center Information

Immunizations & Vision and Hearing Screenings

Weekly Enrollment

Registration Fee

Weekly Pricing

Summer Camp Operational Policies Document

Waiver & Financial Obligations

Final Step !!!!