Summer Camp Registration Template

Summer Camp Registration

GRACIE BARRA CONROE
Early-bird registration ends May, 1, 2026.
Student Information
Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade COMPLETED in May 2026
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Grade Completed in May 2022 (optional)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Cell Number

Area CodePhone Number
E-mail
Confirm E-mail
example@example.com
Do you have previous jiu-jitsu experience?
Emergency Information Other than the name listed above
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Did you "Refer a Friend"? Please tell us the registered camper you invited who hasn't been to Gracie Barra Conroe before! Or tell us who referred you!
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in all activities prepared by Gracie Barra Conroe during the selected camp, including but not limited to strength and agility training, outdoor activities, Brazilian Jiu-Jitsu, Muy Thai and self-defense.
Do you agree to the terms listed above?
Media Disclosure: Gracie Barra Conroe periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on Gracie Barra Conroe's Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Summer Camp. You can also follow us on Facebook to capture all of the pictures yourself!
Do you agree to the terms listed above?
- A $25 non-refundable registration fee can be paid to reserve your child’s spot in summer camp.
- Paying the registration fee will lock in the Early Bird price of $199 until May 1.
- The full tuition must be paid by May 1 to keep the Early Bird rate.
- If the balance has not been paid by May 1, your child will still have their reserved spot, but the price will increase to the regular rate of $299.
- This option allows families to secure their spot now and pay the tuition in increments or anytime before May 1.
- Sibling Discount: Each student—including siblings—must submit a separate registration form with the $25 registration fee. When camp tuition is paid, the $25 fee for each additional sibling will be deducted from their tuition total.
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.
Signature
Checkout

Please select the dates and number of weeks your student will be attending. Submit a separate registration form for each student. A $25 non-refundable registration fee reserves your student’s camp spot and locks in the Early Bird price.
Please select which week your student will be attending:

MonthDayYear
Date
If attending more than one week please indicate which week(s) below:

MonthDayYear
Date
If attending more than one week please indicate which week(s) below:

MonthDayYear
Date
If attending more than one week please indicate which week(s) below:

MonthDayYear
Date
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Camp Registration
$25.00



EARLY BIRD TUITION 1 WEEK

$199.00



EARLY BIRD TUITION 2 WEEKS
$399.00



EARLY BIRD TUITION 3 WEEKS

$599.00



EARLY BIRD TUITION 4 WEEKS

$799.00



Total

$0.00
Payment Authorization
Should be Empty:

Summer Camp Registration

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