KUNG FU PANDA Summer Camp Registration Form 2013
Scarborough Campus
Mississauga Campus
Registering for (please circle which week you are enrolling your child in)
Scarborough Campus
July 8-12
July 15-19
July 22-26
July 29-August 2
August 12-16
August 19-23
August 26-30
Mississauga Campus
July 22-26
July 29-August 2
August 12-16
First name:
Date of Birth:
Address:
Last name:
Age:
Gender:
City:
Postal Code:
Health Card Number:
Family Doctor:
Phone number:
Allergies or medical Conditions:
Parent/Guardian Information
Parent/Guardian name:
Address:
City:
Phone Number: (H)
(W)
Postal Code:
(C)
Parent/Guardian name:
Address:
City:
Phone Number: (H)
(W)
Postal Code:
(C)
Emergency Contact Information
Name:
Phone Number:
Relation:
Name:
Phone Number:
Relation:
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Release and Waiver
In consideration of membership and permission to become involved in the sport of wushu granted to me by WushuOntario and its
affiliated National, Provincial/Territorial sport-governing bodies, I hereby release and discharge WushuOntario, its affiliated
National, Provincials/Territorial Sport-Governing bodies, clubs, coaches, officials, members, agents, officers, and employees from all
claims actions, judgments and executions which the undersigned’s heirs, executors, administrators, or assigns may have , or claim to
have, for all personal injuries, known or unknown and injuries to property, real or personal, caused by, or arising out of, the
participation in the sports activity of wushu and martial arts activities. I, the undersigned understand that all styles of martial arts are
physical and contact sports and thus have inherent risks involved that can result in injury and/or death. I am fully aware of these
risks, but waiver rights, claims, cause of action etc., as heretofore, and do hereby assume the risk completely. I, the undersigned
understand that the products and services provided to my club/school/ gym by WushuOntario, are meant for promotional purposes
only and are not intended for general application for all individual members of my club/school/gym, and it is solely my responsibility
to administer such products and services to those individuals that I have deemed appropriately prepared for engagement in such
programs and services. I also have read and understand the ‘Club Membership Criteria,’ and agree to fulfill the listed requirements. I
also allow WushuOntario to release information on my club for membership purposes including, internal and external
communications, required information by the organization’s insurance company, for legal requirements, and for any disciplinary
actions. I also agree to read and understand the Club Contract, Operations Manual, Rules and Regulations and all WushuOntario and
WushuCanada documents. I also understand and agree that any violation of any WushuOntario policy or rule by any member of my
club/school including by not limited to, an athlete, coach, instructor, official, competitive or recreational member, will result in the
suspension or expulsion of my club from WushuOntario. I, the undersigned, have read this Release /Waiver and understand all of
the terms and conditions; I execute it voluntarily and with full knowledge of its significances.
I have thoroughly read and understand the above waiver.
Yes
Name of Student:
Name of parent or guardian:
No
Date:
Signature:
For Office Use Only
Early drop off/late pick up
Early drop off: 8 am
Late pick up: 5 pm
Member/Non-member
Are you a member of Sunny Tang Martial Arts Centre?
Yes
No
Registering before May 16th
Registering Before June 30th
Registering after June 30th
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