085 MARTIAL ARTS SUMMER CAMP 2026

REGISTRATION FORM – JUNE 15, 2026 THROUGH AUGUST 7, 2026

A premium martial arts, leadership, and adventure summer experience for children ages 5–12.

CAMPER INFORMATION

Camper Name:
{name}

Date of Birth:
{dob}

Address:
{address}

Phone Number:
{phone}

Parent/Guardian Name:

Emergency Contact:
{contact_name}

Emergency Contact Phone:
{contact_phone}

Relationship to Camper:
{contact_relation}

ADDITIONAL REQUIRED INFORMATION

Allergies:

Current Medications:

Medical Conditions or Restrictions:

Authorized Pick-Up Persons (other than parent/guardian):

T-Shirt Size:

Does your child know how to swim?
Yes

CAMP ENROLLMENT

Selected Camp Week(s):

Is your child an active 085 member?

Yes

No

Will your child participate in Extended Care?

Yes

No

STEP UP FOR STUDENTS

Will tuition be paid through Step Up For Students?

Yes

No

If yes, Student Scholarship Number:

REQUIRED DOCUMENTS

Medical Insurance Card:

Any Additional Medical Documentation:

CAMP HOURS

Regular Camp:
Monday – Friday

9:00 AM – 4:30 PM

Extended Care Available Until 6:00 PM

Current 085 members may remain until 6:00 PM at no additional charge and participate in the regular Kids Brazilian Jiu-Jitsu Class from 5:00 PM – 6:00 PM.

Non-members may participate in Extended Care from 4:30 PM – 6:00 PM for an additional fee.

ACKNOWLEDGEMENT

I acknowledge that I have reviewed the Summer Camp Handbook, pricing, policies, transportation authorization, liability waiver, payment policy, and code of conduct.

Parent/Guardian Initials:

Parent/Guardian Signature:

Date:
{sign_date}