Camp Registration-closed

TKDI Boot Camp Registration 2015

August 7-9, 2015
Westview on the James Camp & Retreat Center
1231 West View Road
Goochland, VA 23063

All forms must be filled out completely and all necessary documentation completed in order for your registration to be accepted. All forms and payment must be received by July 24, 2015. There is no registration after that date.

Registration forms can be completed online at www.TKDunion.org, payment should be mailed to 2750 Leighton Road, Shaker Heights, OH 44120. For more information call 216-921-5425 or email [email protected].

PLEASE PROVIDE THE FOLLOWING WITH YOUR REGISTRATION PACKET:

Completed registration form below
Consent for Medical Treatment and Waiver
Camp Fee

Registration Form

Entry Fee for 1st Family Member $295
Additional family members $265 each
Non-participant $235

Payment can be sent by check to:
2750 Leighton Road
Shaker Heights, OH 44120
Or by calling 216-921-5425 to arrange for credit card payment

Registration questions? Email Master James Marr or call 216-921-5425.

* Indicates required field

Name of camp participant *

Parent or Legal Guardian (participants under 18) *

Taekwon-do School *

Current Rank *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender (select from the pop-up list) *

Age *

T-shirt size (select from the pop-up list) *

Meal or accommodation requests *

Emergency Contact Information

Emergency contact 1, name *

Emergency contact 1, phone number *

Emergency contact 2, name *

Emergency contact 2, phone number *

Consent for Medical Treatment

On clicking ACCEPT Adult camp participants consent to medical treatment for injuries/illnesses incurred during the Taekwon-do International summer camp, and authorize treatment by a qualified physician in the event of injury or illness.

If the person completing this form is the parent or legal guardian of a minor camp participant who is under the age of 18, he or she hereby authorizes medical treatment in the event of an injury or illness while participating in the Taekwon-do International summer camp. In the event that the parent or legal guardian, or any of the contacts listed in the Emergency Contacts, cannot be reached in case of an emergency, permission is hereby given to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named above. The parent or legal guardian further agrees to the release of any records necessary for treatment, referral, billing, or insurance purposes.

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND
PARENTAL CONSENT AND INDEMNITY AGREEMENT

In consideration of your acceptance of my registration or that of the minor child, I do hereby, for myself or the minor child, my heirs, executors and administrators waive, release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless any and all rights and claims for damages which I may have or may accrue to me against Taekwon-do International, all instructors at the summer camp, or their respective officers, committees, agents, representatives, successors, sponsors, volunteers, owners and lessor of premises on which the summer camp takes place, assignees and against any camp participant for any and all damages which may be sustained by me or the minor child, in connection with my association with or participation in the summer camp, or which may arise out of traveling to, participating in, and returning from this summer camp.

I understand that all registration fees are nonrefundable.

I understand the nature of Taekwon-Do activities and believe that my experience and capabilities, or that of the minor child, to be qualified to participate in this summer camp. I understand that Taekwon-Do activities may involve risks and dangers of injury, including permanent disability, paralysis and death. These risks and dangers may be caused by myself or the minor child’s own actions, or inactions, and/or the actions or inactions of others participating in the summer camp.

I understand that photos and video will be recorded during the championship. I further give permission for these images to be used in advertising, brochures and other forms of media without compensation.

I have read this agreement, fully understand its terms, understand that I or the minor child have given up substantial rights by signing this and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by the law and agree that if any portion of this agreement is held to be invalid that the balance, notwithstanding, shall continue in full force and effect.

Agreed to by *

By clicking the accept button, you affirm that you are of legal adult age, the registered competitor named above, or the parent or legal guardian of the registered competitor named above, and you agree to the terms of the Consent for Medical Treatment, and the Waiver and Release of Liability outlined above.

(click here to download or print a copy of this agreement)

TKDI Boot Camp Registration 2015

Registration Form

Emergency Contact Information

Consent for Medical Treatment

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND PARENTAL CONSENT AND INDEMNITY AGREEMENT

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND
PARENTAL CONSENT AND INDEMNITY AGREEMENT