2025 Golden Hands Summer Camp Registration Form

2025 Summer Camp Registration

WAITLIST ONLY!!!
Student Information

Please fill out a separate form for multiple students signing up!
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Gender*

MaleFemale
Student's School*
Student's T-Shirt Size
Parent/Guardian Information
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #2 Name

First NameLast Name
E-mail*
example@example.com
Second E-mail (Optional)
example@example.com
Phone Number for Parent/Guardian #1*
Phone Number for Parent/Guardian #2
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler or daily medicine? If yes, please explain any instructions.
Weekly Enrollment

Week Selection. Students are enrolled on a "per week" basis. Please select the weeks your student(s) will be attending. 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: PLEASE NOTE - These are now waitlisted weeks. In the case of any cancellations that pop up, we will notify you of an opening!*

Week #9 (July 28th - August 1st)
Weekly Pricing:

Full-Time Week (7:30am-6:00pm): $300/week per student

Part-Time Week (9:00am - 3:00pm): $200/week per student

Sibling Discount: $35/week discount

Cancellation Fee: $35/week (must provide 2 weeks notice to avoid fee)

Uniform Fee: $40 or $45 (with Red/Green Trim). If you sign up for 2 or more weeks, the uniform is free of charge.

Extra Class Fee (partial day students only): If you or your student would like to stay for our extra karate class (starting at 3:00pm) and get picked up at 4:00pm instead, it is an extra $50/week or $15/day.

Late Pick Up: $10 for every 15 minutes past expected pick-up time.

T-Shirts will be on sale for $25 during the Summer months.

Tuition payments must be made on/before the Monday of each week the student attends. A $20 late fee will be charged on the Wednesday of each week for any accounts that are not current.
Full Time or Part-Time?*

Full-Time Week (7:30am-6:00pm)Partial-Time Week (9:00am-3:00pm)Both: Please Specify which weeks are partial and/or full
Which Weeks?: *
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.
You will receive a welcome email once you register and in which you will be asked to pay the registration fee.
Summer Camp Operational Policies Document

I have read and acknowledge the content of the "Summer Camp Operational Policy Document". This document is available on the Golden Hands web site (www.goldenhands.love). This includes review of our "Discipline and Guidance Policy" as well as the "Gang Free Zones" section.
Operational Policies Document*

Approved
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Golden Hands LLC during the selected camp. In exchange for the acceptance of said child’s candidacy by Golden Hands LLC. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Golden Hands LLC, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Golden Hands LLC, including all instructors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including martial arts. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Golden Hands LLC and its affiliates including Directors, Counselors, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
I give consent for my child to be transported by Golden Hands staff and to participate in water activities.*
Liability Waiver - I am giving permission for the student listed on this form to participate in the Golden Hands Martial Arts 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 Golden Hands LLC. for any accidents that may occur when the student is in their care. I also acknowledge that Golden Hands LLC. does not provide medical insurance coverage for accidents.*

Approved
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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2025 Summer Camp Registration

Student Information

Weekly Enrollment

Registration Fee

Summer Camp Operational Policies Document