Summer Camp Agreement


 Letterhead - Color

Location:   

Parent/Legal Guardian’s Information

First Parent’s Information:
First Name: Last Name: DOB:
Home Phone: Cell Phone:
Work Phone:   Email Address:
Second Parent’s Information:
First Name: Last Name: DOB:
Home Phone: Cell Phone:
Work Phone:   Email Address:  
Home Address:
City/Town: State: Zip:  

 

Camper Information:

First Member’s Information:
First Name:  Last Name:  DOB:  
Second Member’s Information – If Applicable:
First Name:  Last Name: DOB:  
Third Member’s Information – If Applicable:
First Name:  Last Name: DOB:  

 

 

Week Selection and Payment Information:

Number of Weeks:
Weeks Selection

Tuition Rate Per Member:   
Number of Members:
Total Weekly Rate: Please note that in order to qualify for the Current 2017-2018 Member rate, members must be currently enrolled in either the 2017-2018 After School Program OR currently enrolled in the Martial Arts Program of Dragon Yong-in Martial Arts BEFORE this contract is signed.
 
Does this membership qualify for an early bird special ($20 Off Weekly Tuition Rate Per Member)?   
Please note: The early bird special can only be applied if this contract is signed and the proper downpayment (one week of tuition) is paid before April 1, 2017.
Credit Card Information:
Type: Number: Exp: V-Code: Billing Zip:

 Terms & Liability Waiver:

I have read this agreement and understand that once it is signed by me, it is a legally binding and enforceable obligation and I agree to comply with all the provisions, terms and conditions as this agreement set forth.   I also authorize Dragon Yong-in Martial Arts to charge my credit card each of my selected weeks of Summer Camp for the proper amount owed regardless of whether or not my child attends.
I agree to waive any and all claims against Dragon Yong-In Martial Arts and all persons connected with it.
This contract serves as permission to have my child(ren) transported to any health care facility and for him/her to receive any and all emergency health care should a situation arise.
This contract also serves as permission to have my child(ren) transported on field trips during the entire summer camp season.
As we are all aware, children are prone to mishaps. Although Dragon Yong-In Martial Arts makes every effort to have adequate supervision, occasionally accidents can happen. In the instance that an emergency arises we would need your specific permission to transport and have your child treated by a professional care giver/physician etc.
For the safety and well-being of our students and staff, Dragon Yong-In Martial Arts reserves the right to remove any child from our program.

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Dragon Yong-in Martial Arts https://dragonyong-in.com
Signature Certificate
Document name: Summer Camp Agreement
Unique Document ID: 59a9451944588e733fbcdfbb50df84d8196ef854
Timestamp Audit
2016-06-17 11:23:15 ESTSummer Camp Agreement Uploaded by DYMA Sales - sales.dyma@gmail.com IP 71.207.145.17