Lee Brothers Camp Registration

Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #2 Name

First Name Last Name
Birth Date

Month Day Year
Age
Gender

Male Female
Child #3 Name

First Name Last Name
Birth Date

Month Day Year
Age
Gender

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
Would you like to authorize additional people, not listed above, to pick up your child from Lee Brothers Camp?

Yes No
1. Authorized to pick up my child:

First Name Last Name
1. Phone

Area Code Phone Number
2. Authorized to pick up my child:

First Name Last Name
2. Phone

Area Code Phone Number
3. Authorized to pick up my child:

First Name Last Name
3. Phone

Area Code Phone Number
4. Authorized to pick up my child:

First Name Last Name
4. Phone

Area Code Phone Number

Summer Camp Tuition per Week:

Guests

$237

(2nd Child $201)

(3rd Child $166)

Members current TKD or ASP members

$197

(2nd Child $167 )

(3rd Child $138)

Additions: these optional items can be added now or when you come in for camp
Add Late Pick Up Option to my deposit: $10/Week per child
Camp ends at 4pm. This option allows your child to join with our Aftershool Program for study time from 4-6pm.
Add Uniform Rental to my deposit: $15/Week per child
Uniform is required for each camper. Rentals will remain at Lee Brothers.
Add Uniform Purchase to my deposit: $49 + tax
Purchased uniforms are yours to keep.
Deposit

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USD Camp Deposit
deposit
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Lee Brothers Camp for Kids