Camp Location: Texas Karate Institute, 1974 Nantucket Dr Ste 108, Richardson, TX 75080

Time: 9:00 am  to 4:00pm

Fees:  $150 pre-register.  $175 at the door

Bring your own lunch (snacks provided)

Learn Martial Arts, Fun games and activities, Entertainment

For more information call: 972-239-5053

To pre-register print and mail the following information to 1974 Nantucket Dr, Richardson, Texas 75080.  Make checks payable to Texas Karate Institute.

Name: ______________________________

Age: ___________  Date of Birth: _____/_____/______ 

Home Address: _________________________________

City: _____________________ State:____ Zip: _______

Phone:(______)___________   Weight: __________lbs.

Email: ________________________________________

Belt Color:___________ Instructor: _________________

Parents Name:_______________________________

LIABILITY WAIVER.  I, the undersigned, in consideration of the acceptance of entry into the Texas Karate Institute Summer Camp, herein after referred to as the "CAMP" hereby release and forever discharge the producers, directors, and/or other staff members of said CAMP from all and any claims or actions that might occur to me as a result of my participation, admittance, and/or competition in said CAMP included by not limited to any damages or injuries I might suffer during said CAMP.  I assume all responsibility for my entry in the CAMP and do hereby state that I am physically able to compete in this athletic endeavor and have not been heretofore advised by a physician and/or medical authority against activity of this type.  I furthermore acknowledge that I have heretofore participated in a martial arts camp  of this type or have been thoroughly trained and recommended to participate in said CAMP by my instructor who is a black belt in the martial arts

Parent Signature (or Guardian if under 18 years old):__________________________________