2017 Summer Camp Pre-Registration Form
Camp Hours are 9:00am – 3:00pm. Early drop off starting at 7:30am and late pick-up until 5:00 are available at no extra charge. Ages 5-13.
To reserve your spot you must complete this form along with an auto debit form of payment which will be collected on the Monday prior to your camp week. There is also a $25 nonrefundable deposit due at the time of registration to reserve your spot. This will go toward the price of your camp but is nontransferable to other camps.
Please check the box below of the camp or camps you are attending.
Camp 1 June 5th-9th Return of Super HeroWeek
Camp 2 June 12th-16th Pokémon Week
Camp 3 June 19th-23rd Dojang Dodgeball
Camp 4 June 26th-30th Water War Week
Camp 5 July 10th -14th Rock Solid Builder
Camp 6 July 24th-28th Ultimate Nerf Week
I authorize Rock Solid karate to collect the balance due for each camp week on the Monday prior to each camp by:
Credit/Debit Card______
Payment information is as follows.
Name on Credit/Debit card:____________________________
Credit Card Number: __________________________________ Exp. Date:____________ CCV:__________
________ I authorize Rock Solid Karate to debit the credit card account above.
Signature: _________________________________________ Date:__________________________
FILL OUT WAIVER ON BACK
Pre-Registration Price: $135 for Pre-Registration (Deadline May 15th)
Late-Registration Price: $150 for late Registration (After May 15th)
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After School Martial Arts &
Summer Camps
3042 McEver Road, Gainesville, GA 30542
678-450-0055 lee@rocksolidkarate.com
MEDICAL INFORMATION/WAIVER FORM
WaiverDate: _____/_____/_____
Child’s Name: ______________________________________ D.O.B._________________
Child’s Name: ______________________________________ D.O.B._________________
Parents/ Legal Guardian: ____________________________________________________
Primary Phone: __________________________
Secondary Phone: ________________________
Emergency Contact & Phone: _________________________________________________
Family Physician: ______________________________ Phone: _______________________
Medical Insurance For Child: ___________________________ Policy:__________________
Allergies & Medications: ________________________________________________________________
Consent
I (Parent or Guardian) give my consent to Rock Solid Karate, Inc. its officers, agents, employees, individuals associated with the organization or any emergency medical personnel to administer necessary treatment to my child named above in the event of an emergency and authorize transportation for my child by ambulance if situation warrants.
__________ (initials)
I (Parent or Guardian) give my consent to Rock Solid Karate, Inc. its officers, agents, employees, and individuals associated with the organization to transport my child named above to and from Rock Solid Karate’s authorized activities and events.
__________ (initials)
Karate World of Oakwood, Inc. and Rock Solid Karate, Inc. reserve the right to dismiss any students, at any time, for misconduct or actions which may convey a negative image of the martial arts in general and Karate World of Oakwood, Inc. and Rock Solid Karate, Inc. specifically.
I hereby acknowledge that Karate World of Oakwood, Inc. and Rock Solid Karate, Inc. are not responsible for any injuries suffered while on the premises of Karate World of Oakwood and Rock Solid Karate 3042 McEver Road, Gainesville, GA 30504 or any satellite facilities which we are instructing, or off premise field trip locations.
____________________________________ ________________ ___________________
Signature Parent/Legal Guardian Date Instructor
