nunansmartialarts.com: 2022 - 2023 After School Camp Enrollment Form

Start Date *Enter the date you want NMA to start picking your child up from school.

Child's Name *

Last

Date of Birth *

Primary Parent or Guardian's Name *

Last

Relationship *

Home Address *

Email *

Primary Phone Number *

Work Phone Number

Secondary Parent or Guardian's Name*

Last

Relationship *

Home Address (if different than primary parent's address)

Email *

Primary Phone Number *

Work Phone Number

Elementary / Middle School*
Select the school your child attends

Child's Grade*

Elementary / Middle School Address*

I authorize Nunan's Martial Arts to allow my child to leave the facility only with the following persons.

Name

Last

Relation

Phone

Name

Last

Relation*

Phone

List all known allergise, existing illnesses, pregvious serious injuries, injuries during the previous 12 months, any medication prescribed for a long term continuous use and any other medical information. If non, list N/A.

Emergency Contact (other than parents)

Name*

Last

Relation*

Phone*

Name*

Last

Relation*

Phone*

Name of Licensed Physician

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the facility director or person in charge to take my child to the following, if possible, or a physician of their choice.

Name

Last

Address

Phone

Name of Hospital or Clinic

Address

Phone

Digital Agreement *

I give my consent for necessary emergency treatment when my child is in the care of this physician and/or hospital/clinic.

My Child's Records *

My child's immunization record, vision and hearing screening records are on file at the public school listed earlier in the application and all immunizations and tuberculosis test results are current.

Operational Policies Handbook *

I acknowledge the receipt of the operational policies handbook including those for discipline and guidance.

Transportation *
I hereby give my consent for my child to be transported and supervised by the facility's staff (select all that apply).

Give Do NOT Give

Water Activities *
I hereby give my consent for my child to participate in water activities (select all that apply).

Give Do NOT Give

Today's Date *

Digital Agreement *

I give my permission for my child to be picked up from school by Nunan's Martial Arts, LLC and attend any planned field trips with Nunan's Martial Arts, LLC. I realize the staff and directors will do everything in thier power to protect my child during these trips; however, I will not hold them responsible, and waive all claims against Nunan's Martial Arts, LLC for any accidents that may occurduring these times.

2023 - 2024 After School Camp Enrollment Form