Summer Camp Registration

EASTSIDE MARTIAL ARTS

2021 Summer Program Registration

* Indicates required field

Parent Name *

First

Last

Parent Name *

Phone Number *

Name of person(s) picking up your child(ren) *

Child's Name *

First

Last

Child's Name *

First

Last

Age *

Allergies *

Age *

Allergies *

Child's Name *

First

Last

Age *

Allergies *

Child's Name *

First

Last

Age *

Allergies *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you first hear about this event? *

Special Directions/Requests *

Email *

Liability Release *

I, having read the downloadable waiver and release located in the bottom right corner of this form and understand that I give up substantial rights by signing it and knowing this, sign it freely and voluntarily. I agree to participate knowing the risks and conditions involved and do so of my own free will.

Thank You for registering for our Summer Camp. Click submit and you will be taken to our secure payment gateway to complete your registration.

Submit

ema_liability_release.pdf
File Size:	65 kb
File Type:	pdf

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