CRAZY KARATE CAMP ENROLLMENT
Child Name: _________________________________________Age ___ Date of Birth: __________
Address: ________________________City: ____________________ ST: ____ Zip: __________
Home Phone: _________________________ Cell: ______________________
Emergency contact in case you cannot be reached: _______________________ Phone: _______________
Email Address: ____________________________________
Parent/Guardian Name(s): _______________________________
Special Needs/Things to know:
_____________________________________________________________________________________
_____________________________________________________________________________________
“CRAZY KARATE CAMP”
Monday, February 21st
Crazy Fun! Martial Arts, Fun, Games, snacks and drinks provided.
Appropriate ages: 5 to 14
9:00am to 4:00pm
Reserve your spot before February 15th.
Camp Rates
$35.00 per day / $30.00 BBTC
All campers need to bring the following:
Lunch, Sleeping Bag/Pillow (for movie/free time)
DS or PSP (for free time), Book (for free time)
Payment Received: $____________
CASH
CHECK
VISA
MC
AMEX DISC
Card Number: _____________________________ Exp: ____________
Name on Card: ______________________________ CVV: __________
Member represents being physically fit to take the prescribed program. All use of the facilities shall be under taken at the sole risk of the
member. The school shall not be liable to the member for claims, demands, injuries, loss of property or acts of negligence.
DATE _________________ PARENT OR GUARDIAN SIGNATURE___________________________