Name of Child

Age

Date Of Birth

Name of parents/Gurdian

Address

City

State

Zip

Phone

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Please checkbox the week(s) your child will be attending camp!
June 10-14June 17-21August 19-23

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LIABILITY RELEASE I, the undersigned, individually and as a parent / guardian of A minor, ask that he / she be admitted to camp sponsored by Chaar TKD. I do hereby agree to release, discharge, and hold harmlessChaar Tkd Center and Chaar, Inc., its officers, volunteers, agents, and employees of and fromall causes, liabilities, damages, claims or demands whatsoever on account of any injury or accident involving said minor’s attendance atthe camp or in the course of activities held in connection with the camp. Further, RELEASOR agrees to: (1) undergo any reasonable examination ortreatment requested by any first aid providers at the summer camp premises: (2) allow the use by Chaar Tae Kwon Do & MartialArts Center any photographs, whether stillor moving, or (2) at the tournament and/or camp for any purpose without additional consideration to RELEEASOR.

PARENT / GUARDIAN
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