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Lee Brothers Kick’in Kids Summer Camp in Raleigh and Wake Forest

Summer Camp is available from June 11th through the end of August and runs from 7:30am until 4-6pm weekdays. The program offers training to develop skills and experience in Self Defense, Respect & Discipline, Character Development, Confidence & Physical Fitness, all while having fun. Ideal for Ages 6-12

FEE: $179 1st child, $159 for each additional child.
Current Lee Brothers Members $159 1st child, $149 for each additional child.
$50 per week/per child deposit is required to secure your spot. This deposit is non-refundable.

*Please fill out the below form COMPLETELY. All form fields are required!
Once you click submit, you will be taken to a payment page.

Name of your child/ren you are registering:
Required. DOB: Required. / Required. / Required. Age: Required. Gender: M F Please make a selection.Please select only one.
DOB: / / Age: Gender: M F Please select only one.
DOB: / / Age: Gender: M F Please select only one.
Address Required.
City Required. State Required. Zip Required.Invalid format.

Parent/Guardian #1 Name
Required.
  Mom Dad
Email Required.Invalid format.
Home Phone Required. Cell
Work Ext

Parent/Guardian #2 Name
  Mom Dad
Email Invalid format.
Home Phone Cell
Work Ext

Emergency Contact
Required.  Relationship Required.
Phone Required. Is this? Home Work Cell

Name & Telephone of Authorized Persons to Pick Up Your Child/ren (other than parent/guardian listed above):
Phone: Gender: M F Please select only one.
Phone: Gender: M F Please select only one.
Phone: Gender: M F Please select only one.
Phone: Gender: M F Please select only one.

Any Medical Conditions/Medications that need our attention:

Please Note anything that would help us in working with/understanding your child/ren:


TUITION: You have enrolled into Kickin Kids Martial Arts Track-out Care/Summer Camp for the child(ren) stated above.

Your full weekly payment will be expected at the time of drop off each Monday or prior. It will then be your responsibility to attend camp sessions, and no refund/credit will be made for any missed days, whether it is due to sickness, vacation, inclement weather conditions, etc.

Lee Brothers Tae Kwon Do is not a Day Care facility but a martial arts school offering alternative program for children.

Agreement is required for registration. I have read and agree to the above tuition statement.

WAIVER AND RELEASE
I (We) fully understand and agree to the terms of this Agreement. I also understand and agree that Lee Brothers Tae Kwon Do, Inc.’s Kickin Kids Martial Arts Summer Camp/Track-out Camp will not be liable for any injuries that the child receives while under their care. I am aware my child/ren are engaging in physical exercise, including the use of facilities, training and instruction, which could cause injury to my child/ren. I am voluntarily permiting participation in these activities and assume all risks of injury to my child/renthat might result. I hereby agree to waive any claims or rights I might otherwise have to sue Lee Brothers Tae Kwon Do, Inc., its employees or agents on behalf of my child for any injury or harm sustained by any event short of a criminal act, and then only the criminal shall be the subject of such a claim. I further agree that I will not cause to be brought, nor encourage a claim or suit. I also agree not to cooperate in the bringing of such a suit or claim except insofar as I may be legally required to do so. Finally, I shall indemnify the center, its employees and agents for all judgment, costs, attorney fees and other expenses incurred as a result of a breach of this agreement.

I have carefully read this waiver and release and fully understand it is a release of liability. I further agree to release Lee Brothers Tae Kwon Do, Inc. from any liability for any loss or theft of personal property. Lee Brothers Tae Kwon Do, Inc. will make no evaluation or recommendation whether my children are sufficiently physically fit for any exercise activities. It is always advisable to consult a physician before undertaking a physical exercise program.

Agreement is required for registration. I have read and agree to the above waiver.

CHILD CARE AUTHORIZATION
I, legal parent or guardian, hereby grant Lee Brothers Tae Kwon Do, Inc. and their agent the authority to take temporary care of above named child/ren during transportation and track out care or summer camp program activity. The above named caretakers shall have the following powers:

  • The power to transport to and/or from specified points
  • The power to seek appropriate medical treatment or attention on behalf of above named child/ren as may be required by the circumstances. These include, but are not limited to, medical doctor, and or hospital visits, topical first aid.
  • The power to authorize medical treatment or medical procedure in an emergency situation
Agreement is required for registration. I have read and agree to the child care authorization.

Name of Child's Physician: Required. Phone: Required.

Please check which weeks you would like your child/ren to attend

June 2012:
6/11 – 6/15
6/18 – 6/22
6/25 – 6/29

July 2012:
7/2 – 7/6 (NO CAMP - Offering Daily Care)
7/9 – 7/13
7/16 – 7/20
7/23 – 7/27

August 2012:
7/30 – 8/3
8/6 – 8/10
8/13 – 8/17
8/20 – 8/24

 

     
   
 

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