NORTH WIND MARTIAL ARTS ACADEMY

NORTHWIND MARTIAL ARTS ACADEMY
2024 Summer Camp Application Form

Camp is offered Monday - Friday from 8 a.m. - 6 p.m.

May 28, 2024 - August 8, 2024 (Closed July 4 and 5)

Our summer camp offers two hours of daily karate instruction and a variety of both quiet and physical activities, including weekly field trips.

ALL FEES ARE PAID AT THE BEGINNING OF THE WEEK

Summer Camp Fee:
- $175/week for full-time (second child 10% off)
- $50 per DAY RATE for part-time (second child 10% off)
- $50 registration fee for new students (includes karate uniform) (second child $30) Please select which weeks your student(s) will be participating:
All Nine Weeks (May 28 - August 8)
Select weeks
First Child

Student's First NameStudent's Last Name
Age
Date of Birth

MonthDayYear
Date
Second Child

Student's First NameStudent's Last Name
Age
Date of Birth

MonthDayYear
Date
Third Child

Student's First NameStudent's Last Name
Age
Date of Birth

MonthDayYear
Date
Parent/Guardian 1 Name
Email
Cell Phone
Other Phone
Address

Street Address

Street Address Line 2

CityState / Province

Zip
Parent/Guardian 2 Name
Cell Phone
Other Phone
Address

Street Address (if different)

Street Address Line 2

CityState / Province

Zip
Emergency Contacts: Students will be released only to the custodial parent(s) or legal guardian(s) and the persons listed below. These persons may also be contacted in case of an emergency in which the custodial parent(s) or legal guardian(s) cannot be reached:
Name
Phone Number(s)
Name
Phone Number(s)
Name
Phone Number(s)
Medical Information: I hereby grant permission for the staff of this facility to contact the

following medical personnel to obtain emergency medical care if custodial parent(s) or

legal guardian(s) cannot be reached:
Initial
Hospital Preference
Insurance Information
Initial
List any medical conditions we should be aware of
Initial
List any medication(s) your child is taking at this time
Allergies, special dietary needs, or other areas of concern
Allergies, special dietary needs, or other areas of concern

Parents will provide a NUT free lunch & 2 snacks each day for their child. Initial:
Initial
MARTIAL ARTS BACKGROUND/HISTORY

Has your child studied martial arts in the past? No:Yes:
If yes, what style and how long?
HOW DID YOU HEAR ABOUT NORTH WIND MARTIAL ARTS ACADEMY?
Student (or legal guardian/parent of student) hereby represents that he/she is physically fit to take the prescribed course of instruction, that he/she has had an opportunity to observe and/or participate in the art of self-defense prior to the signing of this agreement, and that no oral or written representations have been made to him/her except as expressly written in this agreement.
Initial
Student further acknowledges the existence for the potential of significant personal injury as a result of participating in an activity such as Karate, Judo, but not limited to: Fitness Kick-Boxing, Grappling/Wrestling, Self-Defense and Personal Fitness Training, and that he/she is assuming this risk without liability to the School or instructors by executing this agreement and participating in said course(s) of instruction.
Initial
Failure to take advantage of classes offered does not relieve the Student of his/her obligation to pay his/her course in full. Student is obligated to make all payments whether or not he/she attends class. All lessons are subject to schedules to be established by the School from time to time. Initial:
Initial
Student must notify the School in writing within ten (10) working days of any change of address and immediately for any change of telephone number.
Initial
Student (or legal guardian/parent of student) has read and understands all of the contractual terms set forth in this agreement.
Agreement accepted by Purchaser
Date

MonthDayYear
Date
North Wind Martial Arts Academy Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

NORTHWIND MARTIAL ARTS ACADEMY