Wilde Lake Karate Summer Camp 2021 Registration Form
(Must Fill out for each Child)

Any one other than parents picking up your child-We will ask for ID
Provide insurance card by uploading below or send a copy
Ex: Can swim in 4 Feet comfortably or None at all
Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? if Yes Please Explain. Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive? if Yes Please Explain. (Must Answer Yes or No)
For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication? if Yes please Explain
Please make the weeks your child will be attending.

Registration Fee $65.00 Per Child Included 1 Camp T-shirt)

$25.00 Activities Fee will be added to your weekly price. The activities fee included all field trips.

Please write days you need camp, Space Limited)
All student must have camp t-shirt everyday-without campy-shirt they may not participate in field trips
I, We Understand that there are numerous risks associated with participation in activities Summer Camp- Before & Afterschool Program, Martial Arts, gymnastics, soccer, basketball, bowling, swimming, skating, any sports, amusement rides, slot car racing, and attendance at water parks and animal shows and any other activities that Wilde lake karate provide to my child…. I acknowledge that any and all of these risks are inherent in these activities and that these activities, and other activities in which my child might be engaged, pose the possibility of severe injury, illness and that the risks cannot be eliminated, altered, or controlled. I also acknowledge that motor vehicle accidents may occur in the course of transporting camp participants to or from other activities. or during before & after school transportation, summer camp, or day camp field trips, I give permission for my child to participate in all Summer Day Camp, before-after, day camp school activities, and any activities that provide by WLK including, but not limited to those described above and weekly schedule. I acknowledge and assume the risks involved in these activities and for any damage, illness, injury, or death resulting from such risks for myself and my child. I approve there are no physical, emotional, or mental problems or limitations associated with my child's participation in summer camp before and after school and all other activities, except as disclosed by me in writing to Wilde Lake Karate. RELEASE, WAIVER OR LIABILITY, AND INDEMNIFICATION In consideration of my child being permitted to participate in Wilde Lake Karate Summer Day Camp, Day Camp, Before & After School Program I, on behalf of myself and my child, do hereby release and forever discharge Wilde Lake Karate and Learning Center, Inc., its officers, agents, representatives, and employees, of and from all manner of actions, suits, claims and demands whatsoever, in law or in equity, with respect to any injury, illness, damage or death occurring to my child while he or she participates in any and all camp programs and activities. I hereby agree to indemnify and hold harmless Wilde Lake Karate and Learning Center, Inc. and its officers, agents, representatives, and employees, with respect to any claim asserted by or on behalf of my child as a result of property damage or personal injury, illness, damage or death, which indemnification and hold harmless includes any attorney's fees and costs. I have read and understood the above and agree to be bound by the terms of this document. Authorization and Waiver I hereby authorize Wilde Lake Karate to act on my behalf in an emergency requiring medical attention or any other humane action. I hereby waive and release Wilde Lake Karate from all liability for any injuries or illnesses incurred. I understand that participation in summer camp, before and after school program (martial arts classes), and all other activities inside and outside the Wilde Lake Karate School involves physical activity and as such carries with it the risk of injury. Should an injury occur, any and all medical expenses incurred are the sole responsibility of the participant or participant’s family, this includes all activities inside and outside this facility. I authorize and give Permission to Ride Form Authorization of Transportation I hereby authorize Wilde Lake Karate to transport my child to any and all activities. In the event that I elect NOT to have my child participate in a particular activity, I will notify the school in writing of my decision. Furthermore, I will make alternative arrangements for my child for the duration of the planned activity. I have documented below all precautions and instructions regarding my child’s medication. I have noted any special Health-related conditions or allergies regarding my child. I agreed to WLK’s SCHOOL DISCIPLINE POLICY as below; Wilde Lake Karate Martial Arts After School Program is a program based on the contract between Parents or legal guardian and their children for taking Martial arts classes. To maintain a safe and quality program, we occasionally find it necessary to apply our discipline policy. We feel that effective and positive ways of behavior management are: 1. REDIRECTION: We will stop the child and calmly learn what has happened, why, and how they see it and then suggest other ways of handling the situation. Then, we will redirect their attention. 2. SEPARATION: We will have the child play apart from the rest of the group and rest for a short time. This allows them to calm down. Then we will explain other ways of good behavior. 3-If a child's behavior remains problematic, a parent conference will be held. If there is little or no improvement in the child's behavior after the parent conference, termination of enrollment may become necessary termination of enrollment will be at the discretion of Wilde Lake Karate’s staff.
I agreed to all the above waiver of liabilities by signing my name on the online form and will provide a copy of this liability waiver to Wilde lake karate & learning center.
Please Type I agree and your name, We will provide you with print out.
let us know any request, questions or ...
By Signing you agreed to Wilde Lake Karate waiver of libillity and all tuition Policy, All weeks must be finalize before 05/01/2020-Use your mouse or finger to draw your signature above