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Camper's Information:
First Name:
Last Name:
Date of Birth
Health Card Number
Age
Does the camper have any emotional, behavioural, physical, dietary, allergies, asthma, or any other medical conditions we should know?
If “YES” please state very clearly here.Tell us more
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Doctor Information
Doctor's Name
Doctor's Telephone
Camp Information:
Please check mark the camp(s) your child will be attending:
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YouthPlease choose one
Adult Sizes
Payment Information
Payment MethodInvoice will be sent prior to payment processing.
Credit Card
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Parent Information
Parent #1Enter Full Name
Parent #2Enter full name
Address
Home Phone Number
Cell Phone Number
Emergency Contact other than Parents
Phone Number
Waiver | Consent
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WAIVER/CONSENT: I understand that in the event of an emergency, my child may require prompt medical attention. I give permission for my child to be taken to the nearest medical facility, if the School cannot immediately reach me or another emergency contact. I give consent for the attending medical practitioner to treat, medicate, hospitalize, or order anesthetic or surgery for my child. I understand that I am responsible for any medical expenses incurred for such treatment. The School will take all reasonable precautions to ensure the health and welfare of my child while participating in the Camp Kia programme(s). I agree to release East West Karate and its instructors, directors and employees from all actions, complaints or proceedings arising out of my child’s participation in the summer camp programme. East West Karate has my permission to use any pictures or videos taken of my child, to promote the summer camp program. I hereby give my child permission to accompany the camp instructors of East West Karate on various trips for the camp programme(s) (July-August 2016).I have read and agree to the above conditions.

Do you agree to waiver/concent:
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About Us

 

Martial Arts in the Mississauga, Brampton, Oakville Area.

East West Karate & Fitness specializes in helping people develop a healthy mind and body, and to feel more secure through quality, comprehensive, and professional karate instruction. Whether your goal is self-defense, greater confidence, physical conditioning, stress reduction, flexibility, coordination or sport, East West Karate & Fitness is the POWERFUL ALTERNATIVE that will get you the results you are seeking.

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Contact Info

 

East West Karate & Fitness
Phone:    (905) 891-9448
Email:     gojueastwest@hotmail.com
Address: 1107 Lorne Park Road #9, Mississauga, Ontario L5H 3A1

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