• Summer Camp Enrollment

    Summer Camp Enrollment

    These forms are required for your children to attend camp.

  • Camper's Information

  • Date of Birth*
     - -

  • NOTE - It is recommended that children have completed 2nd grade to participate in the summer camp.

  • Camper Martial Arts Experience*

  • Parents' Information

    Parent/Guardian 1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would you like to be reached while your child is at camp?*

  • Parent/Guardian 2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would parent/guardian 2 like to be reached while your child is at camp?

  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the school, able to take responsibility for the child in case the parent/guardian cannot be contacted. The first emergency contact must live no more than 1 hour away.

  • Emergency Contact #1
  • Format: (000) 000-0000.

  • Emergency Contact #2
  • Format: (000) 000-0000.
  • Do you authorize your camper to check in and check out without supervision?*

  • Medical / Health Information

  •  -

  • Insurance Information
  • Is the camper insured with medical / hospital insurance*
  • Subscriber's Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is the Camp up-to-date on all immunizations?*
  • Does your child have any food, medication or environmental allergies?*
  • Allergies? Check all that apply*
  • 0/150
  • Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*
  • Does your child have a special health or medical condition?*
  • 0/150
  • Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?*
  • Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?*
  • 0/150
  • If yes, does this medication, food supplement, or medical food need to be administered at the day camp?*
  • Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*
  • 0/150
  • Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?*
  • 0/200

  • Mental Health
  • 0/200

  • Payment and Statement of Understanding

  • Be sure to contact us: mokwondo@gmail.com before paying if you would like a sibling discount for signing up two children or if you would would like credit for a referral. Cash, check, and venmos only for discounted transactions.

     

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        Credit Card
      • Sign Document*
      • Date Signed*
         - -
      • Should be Empty: