Mo Kwon Do Summer Camp Enrollment

Summer Camp Enrollment

These forms are required for your children to attend camp.
Camper's Information
Member ID
Camper Name*

Last Name
Nickname
Date of Birth*

MonthDayYear
Age
NOTE - It is recommended that children have completed 2nd grade to participate in the summer camp.
Entering Grade in 2018/19*
School Camper Attends*
Camp Registering For?*
T-Shirt Size*
Camper Martial Arts Experience*

Absolute Beginner6 Months experienceGreater than 2 years experience
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.
How did you hear about us?*
Google, Social Media, Referral - if so who?

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work*
Or enter N/A if not applicable
Parent's Work Phone
Parent's Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?*

Cell PhoneWork Phone
Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name*
Or enter N/A if not applicable
Parent's Work Phone*
Parent's Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork Phone

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
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*
Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*
Do you authorize your camper to check in and check out without supervision?*

YesNo, only with authorized pick up

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.

My Products

Camp Tuition$600.00

One Week Sparring Gear Rental$50.00

Total $0.00

Mo Kwon Do has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info
Should be Empty: