RLMA - Summer Camp

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Camper Name
First Name
Last Name
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Camper Age
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Camper T-shirt Size
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Please list medical conditions, allergies, medications and all important info here* This field is required.
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Camper Name
First Name
Last Name
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Camper Age
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Camper T-shirt Size
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Large
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Parent / Guardian Name* This field is required.
First Name
Last Name
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Email
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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Choose your camp weeks:
Week 1 - June 2nd-6th
Week 2 - June 3rd-13th
Week 3- June 16th-20th
Week 4 - June 23rd-27th
Week 5 - June 30th-July 3rd (pro-rated)
Week 6 - July 7th-11th
Week 7 - July 14th-18th
Week 8 - July 21st-25th
Week 9 - July 28th-August 1st
Week 10 - August 4th-August 8th
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Do you need to add extended care 7:30am-8:30am?* This field is required.Regular camp hours are from 8:30am-6:00pm. Extended care is an additional $25 per week.
YESNO
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Would you like to add Enhanced Training?* This field is required.Enhanced training is an intensive athletic development program that includes beach training, self-defense, sparring & wrestling. Enhanced training is an additional $25 per week.
YESNO
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Authorized Pick Up ListPlease include the name of all persons authorized to pick up your child. Please inform authorized parties that they will be required to show ID.
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Reserve your space in camp* This field is required.
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ORDER SUMMARY
Total costUSD
Reserve your Ninjas space in camp!The reservation fee is non-refundable.
$75.00Edit
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Reserve your 2nd Ninjas space in camp!
$50.00Edit
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Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
ACH Bank Transfer
Account Holder Name
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By signing below I agree to all terms and conditions as outlined on this registration form and as stated at raiseleaders.org/terms. Medical Treatment: I hereby give permission for my child to be given CPR and first aid treatment by a qualified staff member of the RLMA, LLC (Raise Leaders Martial Arts) staff. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital selected by the RLMA, LLC (Raise Leaders Martial Arts) director when deemed immediately necessary or advisable by the physician to safeguard my child’s health. Insurance: I understand it is my responsibility to provide for my child’s accident and health coverage while participating in these programs and I further understand that RLMA, LLC does not provide this coverage. Payment and Refunds: I acknowledge that there is limited space in camp due to safety precautions and special restrictions regarding the COVID-19 pandemic and therefore my reserved space is non-refundable. Payment: I agree to pay my camp fees before the first day of camp attending based on the terms of this agreement. I authorize RLMA LLC to charge my card via Intuit Quickbooks credit card processing and Square payment services. I understand that it is my responsibility to bring any billing discrepancies to RLMA, LLC (Raise Leaders Martial Arts) attention within 60 days after they first appear on my financial statements. After 60 days, I waive my right to dispute such discrepancies. Participation: I give permission for my child to participate in all activities and classes at RLMA, LLC (Raise Leaders Martial Arts). I give permission for my child to be transported to and from said activities. This form is valid for Camp, January 1st 2025-January 1st 2026. Release from Liability and Indemnification: Recognizing that RLMA, LLC (Raise Leaders Martial Arts) will do its best to ensure a safe experience, I understand that accidents may occur from my child’s participation in program activities. I agree to assume these risks. By signing below, I release RLMA, LLC (Raise Leaders Martial Arts), its owners, officers, employees, volunteers, independent contractors, directors and agents from all liability based on any damage, loss, injury or death whether it is the result of ordinary negligence or otherwise, caused to my child or to me from participation in RLMA, LLC (Raise Leaders Martial Arts) programs. I further agree to indemnify and hold RLMA, LLC (Raise Leaders Martial Arts) harmless from all claims that are in any way connected with my child’s participation in this program. Photography, Videography and Social Media: Permission is given to RLMA, LLC to use photographs and videos of myself/child (regarding martial arts and RLMA, LLC programs and activities) in promotional material.* This field is required.
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