Winter Break Day Camp A

Champion Sport Karate
1712 Charleston Drive, Papillion, NE 68133

The Winter break Camp is available for all children ages 4 to 12 from 7:30 am to 5:30 pm. *Bounce Time * Gym Games * Board Games * Fun with Friends
$45 per day
Current students already enrolled in the after school program please use the After School Program Winter Break Camp Registration Form for Discount

Your Information

E-mail

First name

Last name

Phone

Additional Questions

Name/Age/Birthday of Child attending

Name of Parents and phone numbers

In case of Emergency please list the name and phone number and relationship to the child

Please list any allergies, medical issues, medication or any activities in which your child should not engage in. (optional)

Authorized person to pick up your child inlcuding parents/guardians and relationship to child. (optional)

I understand that I am responsible for payments of all days registered, whether my child attends or not.

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).

Medical release waiver

Friday, February 9 Day Camp

(Max of 25)

Discount or Gift Card Code

Order Total: $0.00

Winter Break Day Camp A

Your Information

Additional Questions

Discount or Gift Card Code

Credit or Debit Card