DON’T MISS SPECIAL SPRING BREAK PRICES!!

            

Discover the Champion in You!
Teen Leadership
 & Confidence Camps

 

Download the Flyer HERE

 

Leadership Camp is designed for teens 13 and up!

 

Confidence Camp is designed for children 5-12!

 

Person Information
Parent's First Name *
Parent's Last Name *
Parent's Email *
Parent's Phone 1 *
Attendee #1 Name *
Sex *
Age *
Attendee #2 Name
Sex
Age
Attendee #3 Name
Sex
Age
Emergency Contact #1 Name
phone1
phone2
Relationship to child
Emergency Contact #2 Name
phone1
phone2
Relationship to child
Does your child have: Frequent ear infections?
Heart defect/disease
Convulsions
Diabetes
Bleeding/Clotting disorders
Chicken Pox
Measles
Mumps
Epilepsy
High Blood Pressure
Allergies: Ivy poisoning
Insect stings
Penicillin
Asthma
Hay fever
Foods: name
Other: name
Name any operations or serious injuries
Disability or chronic/reoccurring illness
Dietary modifications
Current medication and when taken
My child may participate in all ALL TKD activities except:
Physician name
Phone
Address
Preferred hospital
We don't have a current doctor, please use closest available
Closest available hospital
Dentist Name
Phone
Address
Insurance information: insured by:
Policy/Group #
Does your child have any fears?
What would you hope your child receives from their camp experience? *
Do you have any special instructions or concerns? *