Day Camp Student Agreement

Thank You! You have successfully signed and submitted your Camp Agreement

Please fill in all the required information. (*)

Enrollment Date Start Date Source


1Parent Information

Parent #1
First Name* Last Name* Relationship to Child* Email Address* Cell Phone* Work Phone Address
Parent #2
First Name Last Name Relationship to Child Email Address Cell Phone Work Phone Address
2Student Information

Student #1
Full Name* DOB* Allergies Special Needs/Concerns:
Student #2
Full Name DOB Allergies Special Needs/Concerns:
Student #3
Full Name DOB Allergies Special Needs/Concerns:
Student #4
Full Name DOB Allergies Special Needs/Concerns:
3Emergency Contacts
Contact #1
Full Name Relationship to Child Cell Phone Home Phone
Contact #2
Full Name Relationship to Child Cell Phone Home Phone

4Please list everyone who may be picking up your child on the lines below.
Name #1
Full Name Relationship
Name #2
Full Name Relationship
Name #3
Full Name Relationship
Name #4
Full Name Relationship

1. A returned check will have a service fee of $25.00. For the second returned check a $30.00 service charge will be assessed. Additionally, the above credit card/debit card will be debited for the returned check(s) plus any outstanding fees. Payment must be made in full at time of registration in order to secure your camp spot. Your prompt payment is greatly appreciated.

2. NO REFUNDS.

3. I understand that Loyalist Martial Arts Academy, is a Martial Arts School and not a daycare. In as such, their stock-in-trade is not supervision and care. The intent of Loyalist Martial Arts Academy is to teach Martial Arts, physical and philosophical character building skills. I understand that Loyalist Martial Arts Academy is a Martial Arts School.

4. WAIVER & RELEASE: Buyer and Student(s) agree that Student(s) is engaging in physical exercise, the use of equipment, and the use of Loyalist Martial Arts Academy training and instruction facility, which can be dangerous to the Student(s) and could cause injury to Student(s). Student(s) is/are voluntarily participating in these activities and Buyer and Student(s) assume all risks of injury to Student. Buyer and Student hereby waive and release any claim or right to sue Loyalist Martial Arts Academy, employees or agents for injury to Student(s). Buyer and/or Student have carefully read this waiver and release and fully understand, it is a release of all liabilities and damages to Loyalist Martial Arts Academy because of any injury that may occur. Loyalist Martial Arts Academy will make no evaluation or recommendation whether Student(s) or guests are physically fit for any exercise activities. It is always advisable to consult your physician before undertaking a physical exercise program, particularly martial arts activities.

5. LOSS/DAMAGE/THEFT OF STUDENT’S PROPERTY: Loyalist Martial Arts Academy does not assume any responsibility for the loss, damage or theft of any property belonging to the Student and Student agrees that the school and its personnel are not responsible for or liable for any such property even if its loss, damage, or theft occurs on or about the school’s facility.


5Parent Responsibility Checklist

6Child Responsibility Checklist

7Signature
Signature Here Please



By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.