Skip to content
Call Us Today! (352) 338-7262
|
okitoamericamartialarts@gmail.com
Facebook
YouTube
Instagram
Email
Phone
Home
About
Services
Martial Arts
After-School
Transportation
Cooking Classes
Dance Classes
Birthday Parties
Camps
Events
Contact
Spring Break Form Registration
Spring Break Form Registration
Philip Guiry
2025-02-10T14:20:34-05:00
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Please Select Your Okito America Location
*
OA1-ARCHER RD
OA2-NEWBERRY RD
OA3-ALACHUA
If you have any questions feel free to call us! OA1 (352)-338-7262 | OA2 (352)-338-7262 | OA3 (386)-206-5486
Camper Name
*
First
Last
Parent or Guardian 1
*
First
Last
Parent/Guardian 1 Telephone #
Parent/Guardian 1 Cell #
*
Parent/Guardian 1 Email
*
Parent/Guardian 2 Name
*
First
Last
Parent/Guardian 2 Home Telephone #
Parent/Guardian 2 Cell #
*
Mother
Parent/Guardian 2 Email
*
Are there any special circumstances that the camp should be aware of relating to the family situation?
*
Please note if there are special custody arrangements the camp must have all necessary paperwork on file in the camp office.
Address - Street
*
City
*
Zip
*
EMERGENCY CONTACT - Name
*
First
Last
Relationship
*
Cell #
*
If Billing Address is Different -Name
First
Last
Address - Street
City
Zip
Cell #
FEE SCHEDULE: Please Select Desired Session
*
Full-Day Session - $179/week (7:30 am to 5:30 pm)
One-Day-Session - $49/day (3 days or more count as a week)
Cooking Class Session - $69/per class (classes are held once a week at our Alachua City location)
If One-Day-Session was selected, Please list date(s)
Method of payment
*
CHECK
CASH
VISA
MASTERCARD
ON FILE
*(A $15 Late fee will apply to all payments made after payment due date)*
Credit Card #
Expiration Date
Name on Card
CVC
ZIP
PLEASE INITIAL
*
Full payment is required, there will be no refunds - no exceptions.
PARENT/GUARDIAN SIGNATURE
*
You agree to use an electronic document and an electronic signature. You understand that electronic signatures are legally binding.
DATE
*
A physician's examination is not required. Please Complete this information to the best of your knowledge. Please inform the camp office in writing of any changes to your child's health prior to their arrival at camp.
Camper Name
*
First
Last
Age
*
Birth date
*
Health Card #
*
Family Doctor
*
Doctor Telephone #
*
Allergies
*
Yes
No
If Yes, Please List
Does This Allergy Require an Epi-Pen?
Medication
*
Yes
No
If Yes, What Medication?
Please List Any Medication and doses that your camper will be taking at camp
Please note that all medication must be in its original container and all instructions attached.
Are there any activity restrictions while at camp?
*
Are there any behavior/special considerations that the camp should know about to better facilitate their experience?
*
Please read the following carefully and check off each item to ensure that your registration is processed correctly
*
All Sections of the registration form must be completed
Please ensure that you have signed where indicated in the Parent's Authorization section
Please ensure that the camp has all appropriate information to help your camper have a successful stay
Any health information that changes, needs to be communicated to the camp IN WRITING before your child starts
I hearby give consent for my child to participate in the full Okito America program and all activities(inside and outside the facility during the duration of the 2025 Summer Camp) unless I advise you in writing.
I give permission for Okito America Day Camp to use any photograph my child is in for promotional material. To the best of my knowledge, my child is in good health, and I will notify the camp if he/she is exposed to any infectious diseases. I further release and agree to indemnify and hold harmless Okito America Summer Camp and its officers, servants or assigns from any liability concerning our child’s involvement in the Okito America programs and further agree that the use of all Okito America facilities is made at the risk of the registrant. In case of surgical emergency, I hereby give permission to the physician selected by the camp director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or surgery for my child, as named on this form. Every effort will be made to contact a parent/guardian in the case of emergency.
We are not responsible for any lost, broken, or stolen items
In case your child(ren) is (are) not feeling well, someone will need to pick him/her up to prevent other children from getting sick.
Full payment is required before the attending week, and there will be NO refunds for any payment.
I understand that the Camp Administration reserves the right to dismiss a camper who, in their opinion, is a hazard to the safety or rights of others, or who appears to have rejected the reasonable expectations of the Camp.
Charges will appear on your statement under the name OKITO AMERICA
Outstanding balances after the 2024 summer camp ends will be charged interest of 1% per month.
A taekwondo uniform will be providing for only new full-time students attending more than a week.
PLEASE INITIAL:
*
I agree and understand to the best of my knowledge all points stated above in Checklist
Parent/Guardian Signature
*
You agree to use an electronic document and an electronic signature. You understand that electronic signatures are legally binding.
Date
*
Submit
Page load link
Go to Top
