KCCM Summer 2017 Day Camp
Dates: June 26 - June 29
Event Address: St Thomas Aquinas Parish School,
915 Alton Road, E. Lansing, MI 48823
Email us at:
Grade Camper will be entering in Fall 2017
Camper T-shirt Size (Late registration will not guarantee requested shirt size.)
Parent/Guardian Phone Number
If you able to volunteer, please provide your availability.
Select the camp tuition due
One Camper (K-12th grade): $150
One preschool camper: $80
Second Camper K-12th grade from the same family: $105 (1st camper $150, each add'l $105)
Tuition Payment Method
Mail a check payable to KCCM to P.O. Box 4786, East Lansing MI 48826
Bring a check payable to KCCM the first day of camp
In consideration of the acceptance of my application for the above program, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Korean Culture Camp of Michigan, its board members, officers, counselors, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees. Parental Consent: I give consent for my child to participate in the activities of the camp, and I execute the above liability release on their behalf. Consent for Treatment: I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that KCCM thereof will be at my expense. I have read and understood the foregoing registration liability release and parental consent form, and agree to all of its terms and conditions.
Yes, I agree.
A copy of your responses will be emailed to the address you provided.
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