Summer Sports and Fitness Camp
For students ages 7 -11
2011 Schedule


Week #1: June 27, 28, 30, July 1		Week #6: August 1, 2, 4, 6
Week #2: July 5, 6, 7, 8		Week #7: August 8, 9, 11, 12
Week #3: July 11, 12, 14, 15		Week #8: August 15, 16, 18, 19
Week #4: July 18, 19, 21, 22		Week #9: August 22, 23, 25, 26
Week #5: July 25, 26, 28, 29

2011 Summer camp Application
International Tae Kwon Do Academy
32 Tioga Way Marblehead, MA. (781) 631-8504 / www.tkd.net

Name __________________________________________________ Date of birth ____/____/____

Address ______________________________City/state/zip_______________________________

Telephone(s) __(________)____________________ work__(_________)_____________________

General Health: (please check) Excellent _______ Good _______ Fair _______ Poor________

Are you Allergic to bees? Yes ___ No ___ Don’t Know ___ (If yes, please bring a bee sting kit.)

Any medical problems? Yes ___ No ___ Are you taking medications? Yes ____ No ____

If yes, then please explain? _______________________________________________________________

The above named student would like to enroll in the weeks indicated below.
*All weeks are 4 day weeks, with no camp on Wednesdays with the exception of week 2, when there with be no camp on Monday, July 4.

*All weeks are 4 day weeks. There is no camp scheduled for July 4.
Please list the weeks you want by number: _____________________________ (please refer to the schedule above)
If these weeks are not available, please return my deposit ___
If these weeks are not available, please put me on a waiting list ___
If these weeks are not available, move me to any available weeks ___ However, I can not attend weeks#_____________

Cost of camp: $250 X #of weeks = __________
Deposit paid: $50 X #of weeks = __________
Balance Due: $200 X # of weeks = __________ (______) check here if you have paid on-line

Release and waiver of liability:
In consideration of the services to be received, the undersigned hereby releases the International Tae Kwon Do Academy, its instructors and students, from any liability, by reason of injury, or suffering which may be sustained in the course of receiving instruction or services.
I have read and agree to the Release and waiver of liability, in consideration of the services to be received as a student of the International Tae Kwon Do Academy.

___________________________________ _______/_______/_______
Parent's Signature and date