NORTH WIND MARTIAL ARTS ACADEMY

2025 Summer Camp Application Form

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

We will be closed May 26, 29 and 30 as well as July 4 and August 8.

Our summer camp offers two hours of daily karate instruction and a variety of both quiet and physical activities, including weekly field trips. Email your form to northwindma@gmail.com or drop it off at our Oviedo office.

ALL FEES ARE PAID AT THE BEGINNING OF THE WEEK

Summer Camp Fee: $175/week for full-time (second child 10% off -$18 per day) $50 per DAY RATE for part-time (second child 10% off - $45/ per day) $50 registration fee for new students (includes karate uniform) (second child $30) Please select which weeks your student(s) will be participating:

Weeks Participating

Weeks:

Specific Weeks

Name*

Student's First NameStudent's Last Name

Age*

Date of Birth*

Date

MaleFemale

Student 2 Name

Student's First NameStudent's Last Name

Date of Birth

Date

MaleFemale

Student 3 Name

Student's First NameStudent's Last Name

Date of Birth

Date

MaleFemale

ParentGuardian 1 Name*

Other Phone*

Other Phone

Email*

example@example.com

Address*

Street Address

Street Address Line 2

City

Zip

ParentGuardian 2 Name

Cell Phone

Other Phone

Email

example@example.com

Street Address (if different):

Address

Street Address if different

Street Address Line 2

City

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:

Emergency Name 1*

Emergency 1 Phone Number(s)*

Emergency Name 2*

Emergency 2 Phone Number(s)*

Emergency Name 3

Emergency 3 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*

List any medical conditions we should be aware of:

Medical Conditions

Initial*

List any medication(s) your child is taking at this time:

Medications

Initial*

Allergies, special dietary needs, or other areas of concern:

Allergies

Initial*

Parents will provide a NUT free lunch 2 snacks each day for their child Initial*

MARTIAL ARTS BACKGROUND/HISTORY

Has your child studied martial arts in the past?

Studied Martial Arts?*

YesNo

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*

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*

Date

North Wind Martial Arts Academy Signature

Date