Summer Half Day Camp
Registration Form

Child's name ___________________________________
Address: ______________________________________
City: __________________ Postal Code: ___________
Phone (day): ___________________________________
Phone (evening): ________________________________
E-Mail: _________________________________________

Camp Sessions:
August 9 - 13, 2004 _____ Martial Arts _____ Art Camp

Fees:
Martial Arts Only $90.00
Art Camp Only $75.00
Martial Arts & Art Camp $165.00

Deposit of $40 for each session is required at time of registration. Cheques made payable to "Renseikan Karate and Aikido" or "Zen Living Inc".
Remainder of camp fee must be paid by cheque, postdated one week prior to start of camp session. Please send cheques and registration form to

Renseikan Dojo
1885 Clements Rd., Unit #211,
Pickering Ontario
L1W 3V4.

Consent, waiver and acknowledgement: I hereby consent to my child`s registration in the summer camp program and in consideration of the acceptance of my child`s registration I agree to indemnify and save harmless Renseikan Karate & Aikido and Zen Living Studios , their instructors, members, agents and employees, of and from any liability of any nature whatsoever arising out of or in any way connected with any claims made by or on behalf of the registrant.

________________________________ ____________________
Parent's/Guardian's signature Date

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