Clone of Simple Event Registration Form

Camp Registration Form

Monday August 20 - Friday 24. Drop off starting at 9am. Pickup up at 3pm.
Parents Name *

First Name Last Name
E-mail *
Emergency Contact *

First Name Last Name
Best Phone Number *

Area Code Phone Number
Child's Name *

First Name Last Name
Child's Name

First Name Last Name
Child's Name

First Name Last Name
Registration Days

Full Week Monday 8/20 Tues 8/21 Wed 8/22 Thurs 8/23 Fri 8/24
Any allergies or medical concerns?
Payment Option

Cash (preferred option) Check Credit Card ($15 process fee)
Camp Details:
1 child = $250.00 for the week. More than one child = $235.00/child for the week. $50/child per day for any single days.

Lunch will not be provided. Please bring a packed, non-perishable lunch and water bottle.

Activities will include games, crafts, puzzles, martial arts and bully-busting, fitness tests and more.

Payment in full is expected no later than the first day of camp. Contact us to make payment arrangements and secure your spot. contact@poolesvilleselfdefense.com
Waiver of Liability

I, on behalf of ourselves, members of our family, our heirs, executors, administrators, and assigns, hereby forever release, discharge, and hold harmless, Poolesville Self Defense LLC, Mark Munster and Ray Castro, their families, or any representatives or agents, Fishpool LLC., the property owner/landlord for any injury, loss, or damage to my person or property howsoever caused, arising out of or in connection with my taking part in personal training sessions or martial arts classes, seminars and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Poolesville Self Defense LLC, Mark Munster, Ray Castro, their families, or any representatives or agents, Fishpool LLC or the property owner/landlord.
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Camp Registration Form