Summer Camp 2023 – Wilde Lake Karate

Registration Type(Required)

Current

New

Number of Student/S(Required)

1st Student Name(Required)

First Last

Date of Birth(Required)

1st Child

Age(Required)

1st Child

Does your child have any health conditions?(Required)

Yes

1st Student-including physical, psychiatric, or behavioral issues? If Yes, Please Explain

Please Explain(Required)

Are there any medications, dietary restrictions, allergies, or special needs?(Required)

Yes

1st Student-Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child time at WLK's experience is positive? Please Explain.

Please Explain(Required)

Note To Staff

Please let us know if you have any question, concern or any details you would like us to know about your child.

Covid and Other Vaccinations

My Child is up to date

My Child is NOT up to date

Other

Explain

Swimming ability? Please Explain(Required)

Non-swimmer or Beginner A non-swimmer, may demonstrate paddling and kicking coordination but uses assistance when swimming, may demonstrate a fear of the water Intermediate Demonstrates forward motion in the water on back and front without assistance, endurance and technique need improvement Advanced Able to swim the length of the pool without stopping, demonstrates proficient front and back stroke skills, interested in learning additional strokes

Explain

Camp T-shirt(Required)

Explain

Number of T-shirts You need(Required)

Students Must Wear Camp T-shirts Every Day.

2nd Student Name(Required)

First Last

Date of Birth(Required)

2nd Child

Age(Required)

2nd Child

Does your child have any health conditions?(Required)

Yes

including physical, psychiatric, or behavioral issues? If Yes, Please Explain

Please Explain(Required)

2nd Student

Are there any medications, dietary restrictions, allergies, or special needs?(Required)

Yes

2nd Student-Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child time at WLK's experience is positive? Please Explain.

Please Explain(Required)

Note To Staff

Please let us know if you have any question, concern or any details you would like us to know about your child.

Covid and Other Vaccinations

My Child is up to date

My Child is NOT up to date

Other

Explain

2nd Child

Swimming ability? Please Explain(Required)

Explain

Camp T-shirt(Required)

Explain

Number of T-shirts You need(Required)

Students Must Wear Camp T-shirts Every Day.

3rd Student Name(Required)

First Last

Date of Birth(Required)

3rd Child

Age(Required)

3rd Child

Does your child have any health conditions?(Required)

Yes

3rd Student-including physical, psychiatric, or behavioral issues? If Yes, Please Explain

Please Explain(Required)

Are there any medications, dietary restrictions, allergies, or special needs?(Required)

Yes

3rd Student-Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child time at WLK's experience is positive? Please Explain.

Please Explain(Required)

Note To Staff

Please let us know if you have any question, concern or any details you would like us to know about your child.

Covid and Other Vaccinations

My Child is up to date

My Child is NOT up to date

Other

Explain

Swimming ability? Please Explain(Required)

Explain

Camp T-shirt(Required)

Explain

Number of T-shirts You need(Required)

Students Must Wear Camp T-shirts Every Day.

Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Do you live Outside of US? If Yes Provide MDH-896 Form(Required)

Yes

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

Explain(Required)

Emergency Contact Name(Required)

First Last

Relationship to Student/s(Required)

Explain(Required)

Phone(Required)

Emergency Contact Phone Number

Would You Like to add more Emergency Person(Required)

Yes

Student Doctor Name(Required)

First Last

Student Doctor Phone Number(Required)

Health Insurance Name and ID number(Required)

upload Copy of your insurance card or bring a copy

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.

Dera Parents,

If you know the exact weeks during summer camp, choose option one, which will allow you to select your weeks.

Choose option two if you are unsure which weeks you will need over the Summer break. You can register now and provide us with the final weeks before 05/01/2023.

After registering, we will send you an invoice including discounted registration fee and two (2) weeks of summer camp (if you register for two or more weeks). If you register for one week, you will receive an invoice including the discounted registration fee and one week of the summer camp fee.

Camp Hours and Weekly Prices (Registration Fee $85.00 one time, Activities fee $25.00 weekly)(Required)

8:30am-4:30pm (Weekly $300.00)

6:30am-4:30pm (Weekly $320.00)

8:30am-6:00pm (Weekly $320.00)

6:30am-6:00pm (Weekly $340.00)

Camp Registration Planning(Required)

I know the week for Summer Camp

I don't know the weeks for summer camp (I will provide all the weeks before 05/01/2023)

Other

Explain(Required)

Your invoice will be including discounted registration fee and 2 weeks of camp, must be paid before 03/01/2023

Note to Staff

Please let us know of any requests,

How Did You Heard About us?

Consent

I agreed to all the below waiver of liabilities and I will fill out the online waiver.

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 and I will fill out the online waiver.
http://wildelakekarate.com/waiver-form/

by Signing below I agreed to all Wilde Lake Karate & Learning Center Waiver/Release of Liability Form & Discipline/Regulation policy/membership policy/late fee.*(Required)

Use your mouse or finger to draw your signature above

Today Date(Required)

Payment Method(Required)

Pay Now By Credit, debit

PayPal

I Bring Exact Cash

Invoice Charges(Required)

Price: $10.00

Registration Fee Included a T-shirt till 03/01/2023

The regular Registration Fee is $85.00, and the Training T-shirt is $20.00 (Saving $55.00). Best of all, save your spots for the school year of 2023-24.