Summer Camp Registration

Champion Sport Karate
1712 Charleston Drive
Papillion, NE 68133

The summer camp program is offered Monday through Friday 7:30 am to 5:30 pm all summer long! Specialty Camp Offering Field Trips Everyday! You can sign up for the entire summer or select individual weeks.  

Fees: $165 per week 1st child, $299 per week 2

Customer Information *

Additional Questions

I give my child permission to participate in field trips during the summer program. I give my child permission to swim during the summer program. I give my child permission to walk and ride the van/bus on the field trips provided during the summer program. I give permission to Jumpin’ Jax Summer Camp/Champion Sport Karate permission to use and publish photos, videos, etc for purposes of advertisement
Medication Permission I _________________________have determined that the Jumpin’ Jax Summer Camp staff is competent to give and/or apply mediation my child/children. I understand that Jumpin’ Jax Summer Camp has the responsibility to assess the ability of staff to give or apply medication safely and may give or apply medication to my child as direct by me.
Authorization for Emergency Medical Care I (we) expect to be notified at once in case of accident or illness to my (our) child; I (we) will make arrangements for medial care of my (our) child with the physician or hospital of my (our) choice; If I (we) cannot be reached to make the necessary arrangements, I (we) hereby authorize Champion Sport Karate/Champion Camp to contact my child's physician 0r the nearest hospital for emergency medical treatment. Furthermore, I certify that my child is, to my knowledge, in good health and free of disabilities that would endanger him/her or other children in the Champion Sport Karate program(s).
Transportation Release Parent or guardian: This form must be completed in order for your child to be transported to activities to and from Champion Sport Karate. Transportation will be provided by Champion Sport Karate not a private provider. The signing of the permission slip releases and indemnifies Champion Sport Karate and it’s employees from all liabilities, damages and any claims made by the child or on behalf of the child, including medical expense incurred, should serious injury, loss of property, damage or death occur as a result of his/her participation in the transportation program. We fully understand the nature of the transportation services and the risk of serious injury, loss of property, damages or death associated with these services. The undersigned hereby releases, waives, discharges and covenants not to sue Champion Sport Karate and employees (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned where caused by the negligence of the releases or otherwise while the undersigned is in, upon or about he premises or any facility or equipment therein, or participating in any program affiliated with Champion Sport Karate without respect to location. The undersigned hereby agrees to indemnify and save, and hold harmless the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon or about the Champion Sport Karate premises or in any way observing or using any facilities or equipment of the association or participating in any program affiliated with Champion Sport Karate whether caused by the negligence of the releasees or otherwise. The undersigned hereby assumes full responsibility for and risk of bodily injury, death, or property damage due to the negligence of the releasees or otherwise while in, about, or upon the premises of Champion Sport Karate and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with Champion Sport Karate. The undersigned further expressly agrees that the forgoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State and that any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue to full legal force and effect. The undersigned has read and voluntarily signs the release and waiver of liability and indemnity agreement, and further agrees that no oral representation, statements, or inducement apart from the foregoing written agreement have been made.
Scheduled Payments: We are not charging a deposit for camp however, weekly payments will be withdrawn automatically 2 days prior to each weekly camp start date.

Please select weeks that you will be attending

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