Spring Break Camp - 2019
Capoeira Spring Break Camp 2019 - Registration
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Welcome and thank you for your interest in our 2019 Capoeira SPRING BREAK FUN Camp! We have a full week of fun, excitement, & enrichment in store for your child! Your child will be having a blast learning Capoeira and important life skills specifically designed to transform your child into a confident, focused, and motivated teen, and so much more!
Capoeira is the Brazilian martial art that merges self-defense with acrobatics, music, & dance. Spring Break days are full of excitement where campers learn and are trained in the different aspects Capoeira has to offer all throughout the day. In addition to learning Capoeira, each day is supplemented with tons different games, activities, and fieldtrips, which coincide with the theme of the day, to give your child a complete Spring Break vacation.

Capoeira Activities:
• Capoeira movements & self-defense
• Anti-bullying & leadership training
• Acrobatics: floor and trampoline
• Capoeira Music: learn how to play three different instruments, and songs in Portuguese
• History of Capoeira

Additional Activities:
• Team building activities
• Sports & games
• Kids yoga and stretching
• Arts & Crafts / reading / story time / movies
• Fun daily themes

REGISTRATION INFO

Camp Dates: Monday March 18th – Friday March 22nd
Ages: 3 - 13
Camp Time: 9am – 4pm (7:30am – 6:30pm)
1. FREE early drop off starting at 7:30am
2. FREE lake pickup until 6:30pm
** Additional Extend Hours: Begins at 7:00am and ends at 7:00pm. ($29 extra per week)

Each Day, Campers Must Bring:
o Lunch with two extra snacks
o Water bottle
o Capoeira uniform or camp shirt
o Shoes for outdoor play

CAMP FEE:

1. Weekly Rate: $149/wk
2. Half Days: $109/wk or $35/day (7:30am – 1:00pm) (1:00pm – 6:30pm)
3. Daily Rate: $40/day
4. Sibling Discount: $10 discount off Regular Full weekly rate only
**If you have a PROMO CODE FOR A SPECIAL DISCOUNT please enter it below**

Registration Fee:
New campers / non-students: $15 includes uniform shirt for camp
Current Students: $0

HOW DO I ENROLL

1. Completely fill out this online registration form.
2. A member from our staff will contact you with 48 hours to confirm your registration.

Email address *
Parent #1 - Full Name *
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Parent #2 - Full Name
Your answer
Parent #1 - Phone *
Your answer
Parent #2 - Phone
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Additional Contact Numbers
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Home Address *
Your answer
Child(ren) Name *
Your answer
Child(ren) Date Of Birth *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Typical Drop-off and Pickup time *
Your answer
Does your child(ren) have any allergies? If so, please explain. *
Your answer
Does your camper require an EpiPen? *
Please provide details about your camper's anaphylaxis, including the date and description of the reaction.
Your answer
Name(s) of all other person authorized to pickup your child (in addition to Parents & emergency contact) *
Your answer
Registration Options *
Required
Promo Code
If you received a promo code with a special discount enter it below. All promo codes are time sensitive. Expired promo codes will not be honored.
Your answer
Payment Options *
Registration is confirmed once payment or non-refundable $20 deposit has been received. Expired promo codes will not be honored.
Required
Additional Notes:
Please use this section for comments and questions. **Campers registering for select days instead of the full week please note the days below.
Your answer
Camp Information & Policies *
Payments: Full payment is due by Friday, March 15th. If payment is not received by the start of business on Monday, a $15 late fee will be automatically applied. Please fill out the attached payment authorization form with your credit card information. Declined Payment: Declined payments will result in a $15 fee. There is a $30 fee for every returned check. Absence: Please contact us by 10am if your child will not be attending camp on a certain day.Refunds: There are no refunds or prorated credits for missed sessions due to sickness, vacation, or any other reason. The registration fee is non-refundable. If you withdraw from camp, and you have authorized us to charge your card for your payment, your money will be refunded in the following manner: Two weeks (or more) prior to beginning camp: 100% refund. One week prior to camp: 75% refund. Less than 1 week: 50%. No refunds will be granted once camp has started.Uniforms: Uniforms are required for all Capoeira classes. Students not wearing their full uniform may not be able to participate in class or other activities. **New campers are only required to wear their camp shirt for classes. Lunch & Snack: Please pack a healthy lunch and snacks (2) to send with your child each day. Pickup Time: Students may be picked up as late as 6:30pm at no additional cost. Students picked up later than 6:30pm will be charged $10 per 15 minutes late. Photo / Video: The parent/student understand and give permission to Capoeira Brazilian Pelourinho (referred to herein as CBP) to be photographed / video recorded and published or used in any lawful purpose. Capoeira Brazilian Pelourinho retains all rights of ownership to any video and photographs taken during classes, events, demonstrations, or any other activity in connection with Capoeira Brazilian Pelourinho. Personal Belongings: CBP employees & volunteers shall not be responsible for damaged, lost or stolen articles, inside or outside the facility. Emergency Care Waiver: I hereby give my consent to Capoeira Brazilian Pelourinho, Inc, its instructors, employees, or any emergency medical personnel to administer necessary treatment to my child in the event of an emergency and to transport him/her by ambulance if the situation warrants. Discipline & Conduct: At all times, students must exhibit respect for themselves, respect for other students, respect for instructors, and respect for our facility. Parents are expected to support us in enforcing this policy. Please, no video games / electronics!
Required
Emergency Care Waiver *
I hereby give my consent to Capoeira Brazilian Pelourinho, Inc, its instructors, employees, volunteers, or any emergency medical personnel to administer necessary treatment to my child in the event of an emergency and to transport him/her by ambulance if the situation warrants.
Required
Liability Waiver Release - Terms & Conditions *
In consideration of being permitted to participate in any way in a Capoeira Brazilian Pelourinho (CBP) programs as indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the participant or the parent(s) and/or legal guardian(s) (if participant is a minor) named below agree: 1) I/We fully understand and acknowledge that:a. There are risks and dangers associated with participation in martial arts classes and other activities, which could result in bodily injury partial and/or total disability, paralysis and death. I /We RELEASE and hold harmless, Capoeira Brazilian Pelourinho officers, instructors and assistants from all liability for my personal safety.b. There may be other risks not known to us or are not reasonably foreseeable at this time.2) I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.3) I/We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Capoeira Brazilian Pelourinho, its owners, their directors, instructors, assistants, volunteers, the martial arts facility used by the participant, including it owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasee”. From all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next to kin For any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise.4) I hereby give my consent to CBP, its instructors, employees, volunteers, or any emergency Personnel to administer necessary treatment to me or my child in the event of an emergency and to transport him/her by ambulance if the situation warrants. I assume all costs associated with any medical care, treatment, or transportation. 5) I/we assume all risks and hazards incident to such participation including transportation to and from the activity; and I/we do hereby waive, release, absolve, indemnify and agree to hold harmless CBP the organizer, sponsors, supervisor, participants and person transporting myself and / or my child(ren) to and from activities, from any claim arising out of injury to myself or my child, whether the result of negligence or any other cause. I give permission for my child to attend trips provided by the CBP with transportation provided through a third party or a CBP vehicle.6) In the event of a serious accident or illness, I request that CBP contact me. If I cannot be reached, CBP may make whatever arrangements are necessary to provide emergency care and treatment for my child. This may include conveyance to treatment at a hospital or other medical facility. I will assume responsibility for payment for services rendered. In case of an accident or illness where immediate treatment of my child is not necessary, but where he/she is unable to remain at the CBP I request that CBP attempt to contact me first at the numbers that I have provided to arrange transportation for my child. In the event that I cannot be reached, please contact the emergency contact I have listed.7) I understand that CBP and is a drop-in facility and that such, my child(ren) is/are free to come and go. If my child(ren) is/are to stay in the facility it is because of my direction and not Capoeira Brazilian Pelourinho, Inc. 8) There are no expectations of childcare. CBP is a martial arts school and not a day care in as such, their stock and trade is not supervision and care. The intent of CBP is to teach martial arts and physical and philosophical character building skills. 9) I, the enrollee or the member, irrevocably authorize CBP and those acting under it’s authority, to copy, use, publish, advertising, trade, or any other lawful purpose whatsoever, photographic portraits, pictures or videotapes of me, in which I may be included in whole or in part. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT AND I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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