Camp Tonchu 2013

1. Registration Please circle the week/s your child will be attending: July 8-12 July 15-19 Camp Tonchu 2013 1st Childs Name ____________________________ Age______ Gender M___ F ___ Medical Conditions/Food Allergies ________________________________________ 2nd Childs Name ____________________________ Age______ Gender M___ F ___ Medical Conditions/Food Allergies ________________________________________ 3rd Childs Name ____________________________ Age______ Gender M___ F ___ Medical Conditions/Food Allergies ________________________________________ Home Address _________________________________________ Apt # _________ City ____________________________ County ___________________ Zip _______ Home # _______________ Cell # ___________________ Work # _______________ 2013 Camp Tonchu Registration

2. Registration Parent/Guardian Information Father/Guardian Name _________________________ Email ___________________ Place of Employment __________________________ Daytime # ________________ Address (if different than child) ___________________________________________ Mother/Guardian Name _________________________ Email __________________ Place of Employment __________________________ Daytime # ________________ Address (if different than child) ___________________________________________ Camp Tonchu 2013 Children will be released only to the person(s) authorized, in writing, by the custodial parent(s) or legal guardian(s). The following people are authorized to remove my child(ren) from the facility: Name _______________________ Relationship _________________ Name _______________________ Relationship _________________ Name _______________________ Relationship _________________ 2013 Camp Tonchu Registration

3. Registration Medical Information/Treatment Release Please let us know of any medical/emotional conditions that will help us take the best care of your child possible. _______________________________________________________ _______________________________________________________ _______________________________________________________ Physician __________________ Physician # ___________________ THIS AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT MUST BE COMPLETED BEFORE PARTICIPATION IN ACTIVITIES. TREATEMENT FOR INJURY WILL BE BASED ON INFORMATION PROVIDED HEREIN. In consideration of your acceptance of this registration, I do hereby, for myself, my heirs, executors and administrators waive, release and forever discharge any and all rights and claims for damages I or my family may have or which may accrue to me or my family against Tonchu Martial Arts Academy/Camp Tonchu and all members or its representatives. I hereby consent to have associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I also agree to save hold harmless and indemnify each and all parties herein referred to above from all liability, loss, cost, claim or damage whatsoever, including death or damage to property. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily. I hereby state my children are physically fit to take the prescribed course on our free will. I understand that enrollment fees and camp fees are nonrefundable. I also understand that if my tuition is not paid by 1:00 PM on Tuesday that my child will not be allowed to participate and any payments received after closing on Monday will incur a $15 late fee. I hereby grant permission for my child/children listed on page 1 to ride with authorized Camp Tonchu staff for field trips. BY SIGNING THIS FORM I AM AGREEING TO ALL TERMS AND CONDITIONS. Parent/Guardian Signature _______________________________________ Date _________ Camp Tonchu 2013 2013 Camp Tonchu Registration

4. Registration Payment/Fees/Extras Camp Tonchu 2013 There is a $50 Registration Fee ($30 for any additional children). **Tonchu Martial Arts Academy Students Registration is $30 for all children applying The fee for the camp is $250 for one week or $400 for two weeks. Camp is from 9a-3p Monday – Friday. There is a special Martial Arts Class offered each day from 3:15-4p for an additional $75/week. You must register for this class in advance of the class. I want to enroll my child in the 3:15-4pm Martial Arts Class Yes No Does your child require a car/booster seat? __________________ **You will need to provide your child’s car/booster seat each day of field trips, Monday – Thursday (weather permitting). If your child does not have his/her car/booster seat, they will not be permitted to go on that days field trip. Your child’s safety is our greatest concern! 2013 Camp Tonchu Registration

5. Registration Parent Participation If you would like to attend one or more of the field trips to act as chaperone, please indicate here. If you have small children you would like to bring along with you, that is acceptable, you and your child will be paid for. List of specific trips will be listed within two weeks of the camp. Please let us know at least one week in advance so that we may have reservations for everyone. Camp Tonchu 2013 Yes, I would like to help chaperone Camp Tonchu field trips I will not be able to chaperone field trips 2013 Camp Tonchu Registration