TURNBULL MARTIAL ARTS

Transcription

1 TURNBULL MARTIAL ARTS 22 nd Annual Tae Kwon Do Camp November 9, 10 & 11 th CAMP THUNDERBIRD 909 E. Welch Rd., Apopka, FL Camp doors open: Friday November 9 Camp Thunderbird do jang for set up & check-in. **Registration from 5:00pm 6:30pm.** **Camp starts at 6:45pm sharp** Testing Black Belts $ If paid by 10/1/18 $ If paid after 10/1/18 $ if paid after 10/15/18 ***************** Testing Color Belts $ if paid by 10/1/18 $ if paid after 10/1/18 $ if paid after 10/15/18 $ All Belts not testing $ Parents who wish to stay Includes: Testing, 2 nights stay, 4 meals, activities and seminars For payment arrangements see office staff. For payment arrangements see office staff. YOU MAY START PAYING YOUR CAMP FEES NOW. ALL CAMP FEES MUST BE PAID BY OCTOBER 27 TH. ALL PAYMENT INSTALLMENTS MUST BE PAID BY CASH OR CHECK. Camp Packet/Registration will be available soon. First come First served, so make sure you get your Paperwork back early, so your bed is reserved!! Any questions please see office staff

2 CAMP REGISTRATION FORM November 9, 10 & 11 Each camper (Parent and/or Child) MUST HAVE an individual registration form!!! Please PRINT Clearly! M / F Participant s Name Age Sex(circle) Addr ess City State Zip Phone# Cell# address: Current Belt Rank (If Black list DAN): Belt Size: Belt Rank testing for (If Black list DAN): People I would like to share cabin with: Name Gender Age Relationship Participant s Signature (if over 18) OR Parent/Guardian s Signature (if participant is under 18) Date Please Print Parent/Guardian s Name (If participant is under 18) Please include check payable to: D.C. Turnbull s Martial Arts with this application Visa/MC Also accepted T-shirt size: Adult/Youth: S / M / L / XL / 2xl/ 3X FOR OFFICE STAFF USE ONLY PYMT$ CC / CA / CK#

3 MEDICAL INFORMATION FORM (please fill out ALL lines) Participant Name: (Please Print) Phone#: Address City State Zip Emergency Contact Phone# Do you have health/accident insurance? YES / NO If YES, Insurance Carrier Policy# Name of Primary Physician Phone# Do you have any allergies to medications or foods? Y/N If yes, please list Special Food Needs/Dietary Requirements: Are you taking any medications, prescribed or over the counter? If Yes, please list medications and condition(s) Do you have any physical or health disabilities that may be limiting? If so, please explain Do you currently have any of the following symptoms or conditions? (check all that apply) Epilepsy Drug Reactions Back, Neck or Knee Problems Diabetes High Blood Pressure Heart Disease or Heart Attack Chest pains, Heart palpitations or Heart murmur Have you had a stroke? Do you have a history of Heart Disease, High Blood Pressure or Stroke in your family? If you checked any of the above, please explain each condition: List any other conditions or recent injuries we should be aware of Name of Participating Group (circle): DC Turnbull s MA DCT/Breaking Barriers Allen s MA Vargas MA Other: Signature of Participant (if over 18) or Parent/Guardian (if under 18)

4 HOLD HARMLESS AGREEMENT It is the responsibility of each participant to read and understand this Hold Harmless Agreement. I understand that D.C. Turnbull s Martial Arts L.L.C., its officers and managers, employees, volunteers, consultants and contractors, and any persons in private with any of them, including without limitation David Turnbull, each instructor, each student, and each person volunteering in any capacity (together the D.C. Turnbull s Parties ) at [the D.C. Turnbull s Martial Arts Camp] (the Camp ) assume no responsibility for injuries or illness which I or my child(ren) may sustain as a result of my or my child(ren) s physical condition or resulting from me or my child(ren) s participation in any athletic activities, sports programs, the use of equipment, exercise or other activities. In consideration for the right to participate in activities at the Camp and use the facilities at Easter Seals Camp Challenge, I do hereby, for myself, my child(ren), my heirs, executors, and administrators, waive, release, hold harmless and completely discharge the D.C. Turnbull s Parties from any and all liability, legal responsibility, claims, damages, or causes of action arising from any and all damage or injury to my person or property, including death, that may occur while on Easter Seals property or while being provided services by the D.C. Turnbull s Parties, and hereby waive all such claims or causes of action, regardless of their cause. I understand that martial arts is a physical activity and involves a risk of injury, paralysis and even death. I understand and agree to all terms and conditions of this Hold Harmless. PARTICIPANT S NAME: I HAVE READ AND ACKNOWLEDGE THE FOREGOING: SIGNATURE OF PARTICIPANT OR SIGNATURE OF PARENT OR GUARDIAN FOR PARTICIPANTS UNDER THE AGE OF 18 DATE: Have you ever been convicted of any crime or are there any criminal charges pending against you including: misdemeanors, felonies, and/or criminal traffic offenses? YES or NO (circle one). If yes, explain. Include instances where you were found guilty, or entered a plea of guilty or nolo contender (no contest) and/or your plea resulted in incarceration, probation, pre-trial intervention or adjudication withheld, even if sealed. P H O T O R E L E A S E I hereby grant D.C. Turnbull s Martial Arts, L.L.C. and/or Wendi Turnbull permission to interview myself /family, and/or to use my likeness in photograph(s) /video in any and all publications and in any and all other media, whether now known or hereafter existing, controlled by D.C. Turnbull s Martial Arts, L.L.C and/or Wendi Turnbull, in perpetuity. I will make no monetary or other claim against D.C. Turnbull s Martial Arts, L.L.C. and/or Wendi Turnbull for the use of the interview, the photograph(s), and/or the video. Parent/Participant Signature: Date:

5 Camp Thunderbird PARTICIPANT S 2018 HOLD HARMLESS AGREEMENT It is the responsibility of each group member to read and understand this Hold Harmless Agreement! IN CONSIDERATION FOR THE RIGHT TO PARTIPATE IN ACTIVITIES AND USE THE FACILITIES AT QUEST, INC., CAMP THUNDERBIRD, I HEREBY RELEASE, HOLD HARMLESS AND COMPLETELY DISCHARGE QUEST, INC., CAMP THUNDERBIRD, ITS OFFICERS AND DIRECTORS, EMPLOYEES, VOLUNTEERS, CONSULTANTS AND CONTRACTORS, AND ANY PERSONS IN PRIVITY WITH ANY OF THEM, FROM ANY AND ALL LIABILITY, LEGAL RESPONSIBILITY, CLAIMS, DAMAGES, OR CAUSES OF ACTION ARISING FROM ANY AND ALL DAMAGE OR INJURY TO MY PERSON OR PROPERTY, INCLUDING DEATH, THAT MAY OCCUR WHILE ON QUEST, INC., CAMP THUNDERBIRD PROPERTY OR WHILE BEING PROVIDED SERVICES BY EMPLOYEES, VOLUNTEERS OR CONTRACTORS OF QUEST, INC., CAMP THUNDERBIRD, AND HEREBY WAIVE ALL SUCH CLAIMS OR CAUSES OF ACTION, REGARDLESS OF THEIR CAUSE. Group Name: TURNBULL MARTIAL ARTS Participant s Name: I HAVE READ AND ACKNOWLEDGE THE FOREGOING: Signature of Participant Signature of Parent or Guardian for Participants Under the Age of 18. Date:

6 Quest Camp Thunderbird DIRECTIONAL MAP 909 E. Welch Road Apopka, FL From the North: From the Florida Turnpike or SR 50 West, take SR 429 East (toll) to Apopka until it dead ends. Turn RIGHT onto SR 441 South toward Apopka. Turn LEFT onto Park Ave. Go past the post office and turn RIGHT onto Welch Road. Entrance to Camp Thunderbird will be on your LEFT. From the East: Take SR 528 west to SR 417 North. Take the SR 408 exit going West toward Orlando. Get off on the SR 423 exit North. Go about 4 miles and turn LEFT on 441. Turn SLIGHT RIGHT at Piedmont Wekiwa Springs Road (it will become Wekiwa-Springs Road). Turn LEFT on Welch Road. Entrance to Camp Thunderbird will be on your RIGHT. From the South: Take the Florida Turnpike North (toll road) to Orlando. Take the at 1-4 exit going east. Get off at exit 94 (SR 434 West). Go 1 mile, turn RIGHT on Wekiwa-Springs Road. Go about 4 miles and turn RIGHT on Welch Road. Proceed on Welch Road about 1.2 miles. Entrance to Camp Thunderbird will be on your RIGHT. From the West: Take 1-4 East toward Orlando. Take exit 94 (SR 434 West) and turn LEFT. Proceed about 1 mile and turn RIGHT on to Wekiwa-Springs Road. Go about 4 miles and turn RIGHT on Welch Road. Proceed on Welch Road about 1.2 miles. Entrance to Camp Thunderbird will be on your RIGHT.

7 W H AT TO B R I N G T O C A M P! uniforms and your belt 2. Pillow/sleeping bag/blankets (if staying overnight in cabin) 3. Flashlight 4. Sparring gear and weapons 5. Shorts/pants/tennis shoes t-shirts/jacket/sweatshirt 7. Bug spray 8. Books/games/camera/basketball/football/etc. 9. Snacks 10. Any Medicine you need > SEE MEDICAL INFORMATION FORM! 11. List of allergies (food and medical) > SEE MEDICAL INFORMATION FORM! 12. Towels/Bathroom items (soap & shampoo) 13. A good attitude! BELTS MUST BE WORN ALL WEEKEND! > You only need to wear your uniform for testing. <

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9 FRIDAY November 9, :30pm 6:30pm Check- In at camp 6:45pm SHARP Camp Starts 7:00pm 8:00pm Workshop (Master Kathy) 8:00pm 10:45pm Black Belt Forms testing (CLOSED SESSION) 11:15pm Lights Out! At Camp Thunderbird Apopka, FL CAMP SCHEDULE SATURDAY November 10, :00am 8:00am Breakfast 8:30am Testing Black Belts resume Their testing schedule 9:00am Color Belts - Combaton / Padded weapons 10:00am 11:00am Color Belts Pre-testing - Competition: Part I 11:00am 12:00pm Free Time Sunday November 11, :00 8:00 Breakfast 8:30am 12:00pm Testing Black Belts Breaking & Belt Presentation 12:00pm 1:00pm LUNCH On your Own 1:00pm 3:00pm Black Belts resume breaking - if needed. 12:00pm 1:00pm LUNCH 1:00pm 2:00pm Color Belts Testing resumes 2:30pm 5:00pm Movie 4:00pm 5:00pm Highest Ranking Black Belt Creative Breaks. 6:00pm 7:00pm Dinner 7:30pm 8:30pm Surprise Seminar for ALL!! (Master Trento) 8:30pm 11:00pm Camp fire 8-9: Smores Social 10-11pm: Ghost Stories 9:00pm 11:00pm Movie in Cafeteria 11:30pm BEDTIME NOTE: All Seminars, workshops, activities are TENTATIVE and are subject to change!! Thank You, Master Turnbull