SUMMER CAMPS

FOR AGES 3 TO 12

*FIRST SESSION---JUNE 9TH THRU 14TH

*SECOND SESSION---JULY 14TH THRU 19TH

*THIRD SESSION---AUGUST 04TH THRU 09TH

DROP OFF 2:00pm & PICK-UP 7:00pm (MON, WED, FRI) / 6:00pm (TUE, THUR) /

SAT 10:00am TO 12:00noon

ROPE CLIMBING, GAMES, MOVIES, MAGIC TRICKS, KARAOKE,

SELF-DEFENSE, DEMONSTRATIONS, DISCIPLINE COURSES, FUN JUMP ROPE EXERCISES, PICTURES, PRIZES, SNACKS, FIELD TRIPS, TAEKWONDO CLASSES

*****REGISTRATION NOT ACCEPTED AFTER JUNE 1ST 2008.

-REGISTER BY MAY 31, 2008 & GET A FREE TAEKWONDO T-SHIRT!

-YOUR NEXT BIRTHDAY PARTY AT OUR ACADEMY 25% OFF!

-2ND FAMILY MEMBER GETS 50% OFF SESSION FEE!

-SIGN-UP ALL 3 SESSIONS & GET A FREE TKD SUMMER UNIFORM!

 

Pang’s U.S. TaeKwonDo Academy

- International Martial Arts Association Headquarters -

Address: 3400 S. New Hope Road, BLDG. C & D, Gastonia, North Carolina 28056

Phone: 704-867-7600, 824-0155 / Fax: 704-824-0156

Web-site: www.pangstkd.com / E-mail: ptkdbluesky@aol.com

President: Grandmaster H.S. Pang (7th Dan Black Belt)

=============================================================

TAEKWONDO PROGRAM - PARTICIPATION FORM – SUMMER 2008

(PLEASE PRINT CLEARLY! / BLACK OR BLUE INK ONLY)

 

PARTICIPANT’S FULL NAME: (F)_____________________(M)_________________(L)____________________

 

PREFER TO BE CALLED:____________________ SCHOOL & GRADE:___________________/____________

 

AGE:______ SEX:______ DOB:______________ PHONE #: 1)____________________ 2)____________________

 

ADDRESS:________________________________CITY / STATE / ZIP CODE:_____________________________

 

PREVIOUS MARTIAL ARTS EXPERIENCE:_________________________________________________________

 

***DOES YOUR CHILD HAVE ANY CURRENT HEALTH CONDITIONS THAT WE NEED TO BE AWARE

OF (WHICH MAY AFFECT HIS/HER PARTICIPATION IN THIS TAEKWONDO PROGRAM)?  IF YOUR

CHILD HAS NO PHYSICAL PROBLEMS, PLEASE WRITE “NONE” IN THE BLANK BELOW.  IF YOUR

CHILD DOES HAVE A MINOR HEALTH PROBLEM AND CAN PARTICIPATE IN THIS EXERCISE

PROGRAM WITHOUT COMPLICATIONS, PLEASE STATE THE CONDITION / PROBLEM:   ________________________________________________________________________

 

***DOES YOUR CHILD NEED ACCESS TO ANY MEDICATIONS OR ASSISTIVE DEVICES (EX.

INHALERS FOR ASTHMA, ETC.), WHICH YOU WILL BE SURE ARE IN YOUR CHILD’S POSSESSION,

DURING THE TAEKWONDO PROGRAM SESSIONS?  IF SO, PLEASE STATE THE MEDICATION /

DEVICE AND REASON FOR USING IT IN THE BLANK:

________________________________________________________________________

WAIVER AND RELEASE

PARTICIPANT AGREES TO ABIDE BY THE RULES AND REGULATIONS GOVERNING THE CONDUCT AND OPERATION OF INSTRUCTION SESSIONS AND PARTICIPANTS IN ORDER TO PROMOTE EFFICIENCY,

SAFETY, AND RECOGNITION OF THE INSTRUCTION CERTIFICATION, AS PRESCRIBED BY THE

ACADEMY.  THE PARTICIPANT’S UNDIVIDED ATTENTION IS REQUIRED AT ALL TIMES DURING INSTRUCTION SESSIONS.  PARTICIPANT AGREES THAT ALL EXERCISES AND/OR COURSES

UNDERTAKEN ARE AT PARTICIPANT’S OWN RISK.  THE PARTICIPANT UNDERSTANDS THAT THERE

IS A RISK OF PERSONAL INJURY INVOLVED IN THE COURSE OF INSTRUCTION AND WITH THIS

KNOWLEDGE AGREES TO INDEMNIFY AND SAVE HARMLESS THE ACADEMY, INSTRUCTORS, STAFF,

AND ANY OTHER AFFILIATES OF THE ACADEMY FROM ALL LOSSES CAUSED BY ACCIDENT OR INJURY

TO THE PARTICIPANT.

*I CERTIFY THAT MY CHILD IS IN OVERALL GOOD HEALTH AND PHYSICALLY CAPABLE OF

PARTICIPATING IN THIS TAEKWONDO PROGRAM WITHOUT COMPLICATIONS AND ANY ABOVE MENTIONED HEALTH CONDITIONS ARE WELL CONTROLLED AND UNDER THE REGULAR CARE OF A PHYSICIAN.  *I AGREE AND ACCEPT THE TERMS OF THIS AGREEMENT IN ITS ENTIRETY.  *MY CHILD

HAS MY PERMISSION TO PARTICIPATE IN THE TAEKWONDO PROGRAM CONDUCTED BY PANG’S

U.S. TAEKWONDO ACADEMY.

 

*PARENT’S / LEGAL GUARDIAN’S SIGNATURE:________________________________DATE:___________