2018 Camps for Kids
Pacific Northwest Martial Arts Academy (PNMAA LLC) Registration & Liability Release Form
Mother (First/Last) ________________________________Father (First/Last)___________________________________________
Mailing Address ________________________________________ City _______________________ State ____ Zip ____________
Home Phone ___________________ Mother’s Cell Phone ___________________ Father’s Cell Phone__________________
Email Address _____________________________ Emergency Contact____________________________ Phone _________________
Student’s Name (First/Last) ______________________________________ Date of birth ___________ Gender: M F
2018 PNMAA Camps (Mark the camp/camps your child will be attending. Ages are as of camp dates.):
___ Indoor Parkour Spring Break Camp (Ages 7 – 16) April 2 – April 6, 2018 (9am to 1pm)
_____ PNMAA Deluxe Summer Camp (Ages 7 – 16) June 25 – June 29, 2018 (9am to 1pm)
______ PNMAA Deluxe Summer Camp (Ages 7 – 16) July 9 – July 13, 2018 (9am to 1pm)
______ PNMAA Deluxe Summer Camp (Ages 7 – 16) July 16 – July 20, 2018 (9am to 1pm)
All Camp Pricing Includes Washington State Sales Tax:
$150 per Camp per student (or $35 daily per Camp per student)
PNMAA Members receive a $20 discount per child per camp off of the Weekly Camp rate!
Important Camp Information
- A minimum of 5 kids per camp/time are needed. If the camp you signed up for does not fill up, you will be contacted and will have the option of selecting another camp or receiving a full refund.
- Camps must be paid in full one week prior to camp start date.
- Camp pricing is excluded from normal PNMAA class tuition discounts.
- Parent volunteers are welcomed, especially at lunch time when we will be leaving the studio for a nearby park (for eating and open air activities), weather permitting.
- Please provide a daily sack lunch for your child and a water bottle.
- Please make sure your child wears a good pair of tennis shoes for walking to the park (no flip flops, bare feet, Crocs, ballet shoes, etc).
Payment Information: We currently accept cash, checks and credit/debit card payments payable to PNMAA. A $25 returned check charge will be added for any checks returned by the bank. A $75 deposit per camp, per child, is due upon registration. Payment, in full, is due 1 week prior to camp start date.
As the legal parent or guardian, I release and hold harmless Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners, operators, employees and camp volunteers from any and all liability, claims, demands, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises under the control and supervision of Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners and operators or in route to and from any said premises, including walks to and from nearby public parks.
Medical Emergency Release
The undersigned gives permission to Pacific Northwest Martial Arts Academy (PNMAA LLC), its owners, employees and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical health and mental health.
Allergies/Health Restrictions: ___________________________________________________________________
I request that our doctor ________________________ be called and that my child be transported to
______________________ hospital. Please include doctor’s phone number ____________________
Printed Name of Parent/Guardian ___________________________________ Date ______________
Parent Signature ____________________________________________________________________