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The Dojo
Non-Profit
Programs
– Evening Classes
– After School Program
– Summer Program
– Summer Training Camp
Events
Contact Us
The Dojo
Non-Profit
Summer Camp Program Registration
Email
Enrollment Date
*
Start Date
Referred By
Email Address
This information will not be sold, or shared outside the Jon Paul Roberts facility.
Parent Last Name
*
First Name
*
Marital Status
*
Married
Separated
Divorced
Single
Widow
Student 1
*
Date of Birth
*
Student 2
Date of Birth
Student 3
Date of Birth
Student 4
Date of Birth
Address
*
City
*
State
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
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California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
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Iowa
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Louisiana
Maine
Maryland
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Home Phone
*
Work Phone
Cell Phone
Employer
Job Title
Employer Address
City
State
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
D.L. #
*
State Issued
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Spouse/Other Parent
Cell Phone
Employer
Job Title
Employer Address
Work Phone
City
State
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Emergency Contact
*
Relationship
*
Phone
*
Martial Arts School
*
Yes, I understand.
I understand that Jon Paul Roberts TaeKwonDo Summer Program is a martial arts school and not a daycare in as such; Jon Paul Roberts Summer Program stock-in-trade is not supervision and care. The intent of Jon Paul Roberts Summer Program is to teach martial arts physical and philosophical character building skills. I understand that Jon Paul Roberts Summer Program is a martial arts school and is a drop-in facility in as such; my child(ren) is free to come and go. Additionally, if my child(ren) stay at Jon Paul Roberts Summer Program facility it is because of my direction and not Jon Paul Roberts Summer Program.
Payments
*
Yes, I understand.
I understand that payments not received by due date will have a $5.00 late fee accessed. In addition that payment is delinquent for more than one week a $5.00 late fee will be due for the first week, plus a $10 fee for each additional week thereafter, child(ren) will not be admitted into camp until payment and all applicable fees are paid in full. A returned check will have a service charge fee of $10.00 and resulting in the right to have all future transactions made in the form of CASH ONLY.
Absenteeism
*
Yes, I understand.
If your child(ren) have been absent for more than TWO weeks you will lose your place in the Summer Camp Program, unless prior arrangements have been made with Trisha or Jon Paul Roberts.
Waiver & Release
*
Yes, I understand.
Buyer and Student agree that Student(s) is engaging in physical exercise, and the use of equipment, use of the Jon Paul Roberts Summer Camp Program facilities, training and instruction, which can be dangerous and could cause injury to Student(s). Student(s) is voluntarily participating in these activities and Buyer and Student assume all risks of injury to Student. Buyer and Student hereby waive and release any claim or right to sue Jon Paul Roberts Summer School Program, employees and agents for injury to Student(s). Buyer and/or Student(s) have carefully read this waiver and release and fully understand, it is a release of all liability and damage to Jon Paul Roberts Summer Program for any injury. Jon Paul Roberts Summer Camp Program will make no evaluation or recommendation whether Student(s) or guests are physically fit for any exercise activities. it is always advisable to consult your physician before undertaking a physical exercise program, particularly karate activities.
Loss/Damage/Theft of Student Property
*
Yes, I understand.
Jon Paul Roberts Summer Camp Program does not assume any responsibility for the loss, damage, or theft of any property belonging to the Student(s) and Student(s) agrees that Jon Paul Roberts Summer Camp Program and its personnel are not responsible for, or liable for any such property even if loss, damage, or theft occurs on or about Jon Paul Roberts Summer Program facility.
Authorized Pick Up Person Name
Phone
Date of Birth
Authorized Pick Up Person Name
Phone
Date of Birth
Authorized Pick Up Person Name
Phone
Date of Birth