Course Registration Form

Covington Camps 2024

Kids Camp 8 - 4pm (ages 4 - 12)
CHILD/CHILDREN INFORMATION: ($60/ child per day, $30/ 2nd sibling per day, $20/ 3rd sibling, $10/ additional siblings per day) 5 DAY Rates: $225/ 1 child, $325/ 2 children, $375/ 3 children, $425/ 4 children.

BRING A LUNCH / SNACKS & JUICE PROVIDED
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Name

First NameLast Name
Work Number*
Email*
Medical Information / Medical Concerns
Is your child presently being treated for an injury, illness or taking any form of medication? If yes, please explain.
Does your child require a special diet? Food allergies? If yes, please explain.
Emergency Contact Name*
Emergency Contact Phone Number*
Email
Which dates will your child/children be attending camp?
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Payment Options

Check, Cash, Venmo or PayPal. Square & Credit Cards will require a 3% fee added to the cost) make checks payable to "Covington Karate" Please mail checks to Covington Karate at: 1326 W 21st Ave. Covington, LA 70433
A $50 DEPOSIT IS REQUIRED TO RESERVE YOUR SPOT. You may use Venmo or PayPal. If you need to use Square a 3% processing fee is added.
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PayPal
Deposit

$ Free

Venmo
$ Free Quantity

Total

$0.00
To pay via Square please click the link below:

https://square.link/u/MTa6dfJY?src=sheet
I agree to terms & conditions. The participant, legal guardian of participant or spectator (hereinafter referred to individually or together as the "Participant") acknowledges and understands that this program and/or martial arts training are activities that involve physical activity and/or contact, and that participation in this program may result in injury. Participant freely and voluntarily agrees to assume all risks of their decision to participate in this program and/or by entering this establishment, and agrees to be fully responsible for their own welfare. Participants additionally agrees to hold the school, it's owner, contractors, employees, volunteer instructors and all other participants harmless and waves any and all claims, demands, obligations, action(s), causes for action, claims for losses or expenses of any nature whatsoever for any any and all injury, disease, sexual harassment, illness, Covid 19, loss of life or emotional trauma which may be associated with this program or by entering this establishment. If the Participant initiates any such claims, the school, it's owner, employees, volunteer instructors and all other participants are entitled to seek and receive as damages all reasonable expenses, legal expenses and court costs related to to defending any such claims brought by the Participant. Participant or the parent or legal guardian's signature below intends his or her signature to be a complete and unconditional release of liability to the greatest extent allowed by law and verifies this statement. If any portion of this agreement is found to be against the law or contrary to public policy, all other terms and conditions shall survive. *
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Covington Camps 2024

CHILD/CHILDREN INFORMATION: ($60/ child per day, $30/ 2nd sibling per day, $20/ 3rd sibling, $10/ additional siblings per day) 5 DAY Rates: $225/ 1 child, $325/ 2 children, $375/ 3 children, $425/ 4 children.

Which dates will your child/children be attending camp?

Payment Options

A $50 DEPOSIT IS REQUIRED TO RESERVE YOUR SPOT. You may use Venmo or PayPal. If you need to use Square a 3% processing fee is added.