Capoeira Summer of FUN Camp - 2018
Welcome and thank you for your interest in our 2018 Capoeira Summer of FUN Camp! We have a full summer 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. Summer camp 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 week, to give your child a complete summer vacation. By the end of summer, your child will be more fit, focused, and confident!

Capoeira Activities:
• Capoeira movements & self-defense
• Anti-bullying & confidence building activities
• Acrobatics: floor and trampoline
• Capoeira Music: learn how to play three different instruments and songs in Portuguese
• Capoeira history & culture activities

Additional Activities:
• Team building activities
• Sports & games
• Kids yoga and stretching
• Arts & Crafts / Reading / Story time
• Kids mindfulness and meditation activities
• Fieldtrips
• Super fun weekly themes!

Camp Information
Camp Ages: Ages 3+ (high school students may apply within for leadership opportunities)
Camp Dates: Weekly Sessions from June 4th – August 10th (no camp, July 4th)
Camp Hours: 9am – 4pm (7:00am – 7:00pm)
- FREE early drop off starting at 7:30am & FREE late pickup until 6:30pm
- Extend Hours: Begins at 7:00am and ends at 7:00pm. ($49 extra per week)
Camp Fees: PICK YOUR RATE
1. $110/wk when you Pay In Full (must register for at least 9 weeks)
1. Early Registration Rate: $125/wk (weekly payments accepted)
- Hurry! This special is limited to the first 25 children registered!
2. Regular Weekly Rate: $139/wk
3. Half Days: $119/wk or $35/day (9:00am – 12:30pm) (12:30pm – 4:00pm)
4. Daily Rate: $40/day
5. Sibling Discount: $10 discount off weekly rate only (not valid on early registration special)
6. Registration Fee:
- New campers: $99 includes uniform pants & 2 camp t-shirts
- Current students / returning campers: $25/child includes a camp t-shirt
7. Fieldtrips: $12 per week

How Do I Enroll?
1. Completely fill out this online registration form.
2. Save your child’s spot by paying the non-refundable registration fee, which includes your child’s camp attire and a $50 deposit, which will be credited towards your child’s last week of camp. (A CBP staff member will contact you within 48 hours to confirm your camp registration and answer any questions you might have!)

Parent #1 - Full Name *
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Parent #1 - Phone *
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Parent #1 - Email *
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Parent #2 - Full Name
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Parent #2 - Phone
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Parent #2 - Email
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Parent Work Phone Number(s) / Additional Contact Number *
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Home Address *
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Child Name - #1 *
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Child Birthday - #1 *
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Child T-shirt Size - #1 *
Child Name - #2
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Child Birthday - #2
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Child T-shirt Size - #2
Child Name - #3
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Child Birthday - #3
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Child T-shirt Size - #3
Emergency Contact Name & Relationship *
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Emergency Contact Number *
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Typical Drop-off and Pickup time *
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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.
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Name(s) of all other person authorized to pickup your child (in addition to Parents & emergency contact) *
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Registration Options *
Please select "Week Rate" or "Daily / Half Day Rate" for the weeks you would like your child to attend camp. To receive the Early Registration rate, you must register for 7+ weeks. When registering for half days or certain days during the week, use the "Additional Comments" section below to note the days your child will attend. Fieldtrips (often held onsite take place every Wednesday)
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.
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General Terms of Agreement *
This Camp agreement is executed as of the date registration is submitted, by and between Capoeira Brazilian Pelourinho, Inc, hereinafter referred to as CBP / CBP Martial Arts Academy / CFT, and the Responsible Party/Buyer named as Parent #1 or Parent #2, who has caused his/her signature to be affixed hereto.
Required
Camp Operations *
CBP agrees to provide Camp operations to Camper(s) as enrolled during the scheduled camp hours. Responsible Party/Buyer understands that the Camp Fee described under Registration Information is due and payable according to the terms of this agreement whether or not a Camper(s) chooses to attend courses as scheduled. In consideration for CBP providing the camp(s) chosen at registration for the length of time specified, Responsible Party/Buyer agrees and promises to pay the Camp Fee.
Required
Each Day, campers must bring a bag with the following items: *
1. Lunch 2. Two Snacks 3. Capoeira Uniform Pants 4. Campers must wear Camp or CBP Capoeira shirt to camp each day (2018 Camp shirt must be worn on all fieldtrips) 5. Spray Sun Screen 6. Shoes / sneakers for outdoor play 7. Extra change of clothing 8. Water bottle (which can be kept here)
Required
Information & Policies *
Camp Session Dates: Summer Camp weekly sessions begin Monday June 4th and end August 10th Camp Hours: 9am – 4pm 1. FREE early drop off starting at 7:30am & FREE late pickup until 6:30pm2. Extend Hours: Extended care begins at 7:00am and ends at 7:00pm. ($49 extra per week)Drop Off/ Pickup Policy: Campers must be brought into the lobby and signed in each day. A person that has been designated, as an “authorized person” on registration form, must sign in and out the camper each day and if other than parents, must also show a valid photo id. Campers may be picked up as late as 6:30pm at no additional cost. Campers picked up later than 6:45pm will automatically be charged a $15 late fee.Payment Policy: Payments are due on the Friday before services are rendered. If payment is not received by the close of business on the Monday for that week, a $15 late fee will be automatically applied. If payment information changes, notify and update information immediately to avoid a late charge.Registration: Registration fee along with a $50 deposit (to be credited toward the child’s last week of camp) is due at when registering your child to secure his/her place. Registration fee & deposit are non-refundable. Declined Payment: Declined credit card or bank draft payments will result in a $15 fee. Cancelation & Refunds: Camp sessions may be canceled anytime by submitting a written notice 14 days in advanced. No refunds will be granted once camp has started. There are no refunds or prorated credits for missed sessions due to sickness, vacation, or any other reason. *If you have paid in full, your money will be refunded in the following manner: Eight weeks prior to first day of camp: 75% refund. Four weeks prior: 50% refund.Can I Change Weeks?: Yes, you can make changes (switch / add / remove) to the weeks you would like to register for up until May 25th. After May 25th, you may fill out a "Summer Camp Week Transfer Request" form to request a switch. There is a $7 fee each time a this form is submitted and approved. Once your child has started the first session, you may no longer remove weeks (only transfer and add weeks based on availability). Fieldtrips: Fieldtrips take place weekly. Fieldtrips can take place either on or off site! Fieldtrips are an extra $12 per week, which covers costs for all trips that week. Children must wear 2018 camp T-shirt on all fieldtrips! If you do not want your child to attend an offsite fieldtrip, you may bring them to camp once we have returned.Daily Attire: Campers must wear Camp / CBP Capoeira shirt to camp each day and comfortable shorts/pants.Uniforms: Uniforms are required for all Capoeira classes and should be brought to camp each day (capoeira pants & shirt). Students not wearing their full uniform may not be able to participate in class. Photo / Video: The parent/student understand and give permission to Capoeira Brazilian Pelourinho (CBP) / Capoeira for Tomorrow (CFT) to be photographed / video recorded and published or used in any lawful purpose. CBP / CFT retains all rights of ownership to any video and photographs taken during classes, events, demonstrations, or any other activity in connection with CBP & CFT. Personal Belongings: Employees & volunteers shall not be responsible for damaged, lost or stolen articles, inside or outside the facility.Each Day, Campers Must Bring a backpack with the following: Lunch, two snacks, water bottle, Capoeira uniform, spray sunscreen, shoes for outdoor play, and an extra change of clothing.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
Recurring Payment Authorization *
I understand that I have not already Paid In Full for camp sessions, CBP will contact me to add a credit / debit / EFT (check account) information to process my recurring payment for the camp session selected. Camp payments are processed the Friday before the upcoming week of camp. I understand that I am giving CBP permission to debit my account for summer camp on or after the indicated dates. Please note that any late or declined payment fee may change the amount of your schedule payment. If payment information changes, please notify us and update information immediately to avoid any declined payment fee or late charges.
Required
Travel Waiver *
I authorized the summer camp participants stated on this registration form, participating in Capoeira Brazilian Pelourinho, Inc classes, after school program, camps, and/or other programs permission to travel to and from the Capoeira Brazilian Pelourinho and participate in the field trips planned during as part of Capoeira Brazilian Pelourinho activities. I understand that, by signing this WAIVER, I am giving my express consent and permission for employees or persons designated by Capoeira Brazilian Pelourinho to transport my child to and from Capoeira Brazilian Pelourinho events and trips in Capoeira Brazilian Pelourinho-owned vehicles, leased vehicles or private vehicles. I understand that transportation is being made available as a courtesy in order to ensure that my child has the opportunity to participate in the event. I further understand and agree, for my child, and myself that neither the Capoeira Brazilian Pelourinho nor any of their directors, officers, employees, agent or volunteers shall have any liability for any injury or damage to my child’s person or belongings, whether the result of negligence or any other cause, arising out of or relating to transportation of my child to or from events related to or sponsored by Capoeira Brazilian Pelourinho.
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 *
In consideration of being permitted to participate in any way in a Capoeira Brazilian Pelourinho (CBP) / Capoeira for Tomorrow (CFT) 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 / Capoeira for Tomorrow, 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 Capoeira Brazilian Pelourinho / Capoeira for Tomorrow, 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 Capoeira Brazilian Pelourinho / Capoeira for Tomorrow, 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/ CFT with transportation provided through a third party or a CBP/ CFT vehicle.6) In the event of a serious accident or illness, I request that Capoeira Brazilian Pelourinho / Capoeira for Tomorrow contact me. If I cannot be reached, CBP / CFT 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/CFT, I request that CBP/CFT 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, the enrollee or the member, irrevocably authorize Capoeira Brazilian Pelourinho / Capoeria for Tomorrow 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 understand that Capoeira Brazilian Pelourinho, Inc. is a Martial Arts school and not a daycare center in as such, their stock and trade is not supervision and care. The irintent is to teachMartial Arts physical and philosophical character building skills. I understand that Capoeira Brazilian Pelourinho, Inc 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 stayin the facility it is because of my direction and not Capoeira Brazilian Pelourinho, Inc. 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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