2023 Summer Camp
July 10 - 14
Full Name
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First Name
Last Name
Date
*
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Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT / GUARDIAN CONTACT
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
PARENT / GUARDIAN CONTACT 2
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency or Alternate Pick up
This is a person over the age of 16 who is authorized to pick up your child.
Full Name
First Name
Last Name
Relationship
If your child is 12 or older does he/she have your permission to be released on their own at the end of the day? If Yes, Please sign below
Yes
No
Signature
CODE OF CONDUCT
The safety of each individual in the program is of the utmost importance to 4Point Taekwondo Inc. Eachregistrant must recognize a personal responsibility to learn and follow at all times the safety and other rulesestablished by 4Point Taekwondo staff. I hereby agree that any behavior of the registrant that placeshim/herself or others at risk may result in the registrant’s immediate dismissal from the program. Further,if dismissed from the program, I agree to cover any expense(s) arising from such dismissal. I herebyacknowledge and agree that no refund will be granted for dismissal or removal of the registrant at his/herrequest before the end of a program session. In order to ensure the safety and well‐being of all individuals participating in the program, 4Point Taekwondo reserves the right to alter the program at any time without notice or compensation to the Registrant.
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I Have Read and Understand the Code of Conduct
HEALTH HISTORY
The more information you can provide, the better we can meet the needs of your child. This information will be used by the day camp, and your child’s counsellors to support your child. Whatever information you send to us will be treated with confidence and respect
Is the participant under any form of treatment for an illness, condition, or injury?
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Yes
No
If yes, please explain and detail routines, medications, adaptations etc.
Does your child use a puffer?
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Yes
No
Does your carry an Epi-Pen:
*
Yes
No
For:
Allergies:
Cancellations
Requests for cancellations or refunds must be made in writing and submitted to 4Point Taekwondo via email to kick@4pointtkd.com. Cancellation requests received at least 14 days before the start of camp will receive a refund minus an administration fee of $25 per program being cancelled. Cancellation requests received with less than 14 days’ notice will receive a refund minus an administration fee of 50% of the cost of the program being cancelled. Cancellation requests that are received less than 7 days prior to the start of the program being requested to cancel will not qualify for a refund. A doctor’s note is required for cancellations due to medical reasons. Refunds are not granted for inclement weather.
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I have read and understand the Cancellation and Refund Statement.
MEDIA CONSENT RELEASE FORM
PURPOSES: For marketing, advertising, promotional and/or communication purposes, 4Point Taekwondo, from time to time, take photographs and/or video recordings of 4Point Taekwondo based activities or events that include real people, which photographs and video recordings will be placed in the 4Point Taekwondo Photo Bank and which may be used by 4Point Taekwondo, for its own informational, promotional or advertising purposes. For purposes of this Form, “4Point Taekwondo” refers to 4Point Taekwondo Inc. in Canada. By signing this Form, you are consenting to the taking of photographs and/or video recordings of you by 4Point Taekwondo for the Purposes, you are assigning to 4Point Taekwondo, and waiving any rights you have related to, any such photographs and/or video recordings, and you are consenting to the use of any such photographs and/or video recordings, in whole or in part, by 4Point Taekwondo.
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I have read and understand the Media Consent Form
ASSUMPTION OF RISK AND INDEMNIFYING RELEASE
While 4Point Taekwondo staff and instructors will make every reasonable effort to minimize exposure to known risks associated with each Registrant’s participation in a 4Point Taekwondo program, I hereby acknowledge that I and/or my child if I am registering on his/her behalf may be required, depending on the nature of the Program, to participate in various physical activities that may involve risk of injury. In this regard, I agree that I permit the Registrant to participate in the full range of Program activities. In consideration for the Registrant’s opportunity to participate in the Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and forever discharge 4Point Taekwondo, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, from any and all liability for damages sustained in consequence of loss, injury or damage to the Registrant, and from all other actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or property arising out of or connected with preparation for, or participation in, the Program.
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I have read and understand the assumption of risk and indemnifying release.
Medical Emergencies
In the event of an accident, injury or illness involving the registrant, and immediate contact by 4Point Taekwondo with adesignated contact cannot be made, I hereby authorize and grant permission 4Point Taekwondo staff to secure proper medical treatment and authorize on the registrant’s behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering of x‐rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I agree not to hold 4Point Taekwondo responsible for any costs or injury arising out of an emergency situation.
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I have read and understand 'Medical Emergencies'
Medical Emergencies
By signing my name, I acknowledge that I (or we) have carefully read and understand the Media Consent, Assumption of Risk and Indemnifying Release Statement, and Medical Emergencies Statement
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Full Name
*
First Name
Last Name
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