Spring Break Camp - 2020
Welcome and thank you for your interest in our 2020 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 help 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 of different games, activities, FUN, 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 different instruments and songs in Portuguese
• History of Capoeira

Additional Activities:
• Team building activities
• Daily life-skill lessons
• Sports & games
• Kids yoga and stretching
• Arts & Crafts / reading / storytime / movies
• Fun daily themes

Camp Info:

Camp Dates: Monday March 16th – Friday March 20th

Camp Time: 9am – 4pm (7:30am – 6:30pm)
1. FREE early drop off starting at 7:30am
2. FREE lake pickup until 6:30pm
3. Extended Hours (7am – 7pm) **Extra $29

Camp Fees:
*** Early Registration Special: $149/wk (register before 3/9/20)!
1. Regular Rate: $175/wk or $45/day
2. Half Days: $119/wk or $40/day (7:30am – 1:00pm) (1:00pm – 6:30pm)
* $10 sibling discount off week rate

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

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


1. Completely fill out this online registration form.
2. Pay a $20 to save my chid's spot
3. A member of our staff will contact you with 48 hours to confirm your registration.
Parent #1 - Full Name *
Your answer
Parent #2 - Full Name
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Parent #1 - Phone *
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Parent #2 - Phone
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Additional Contact Numbers
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Home Address *
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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 *
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.
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Payment Options *
Registration is confirmed once payment or non-refundable $20 deposit has been received. Expired promo codes will not be honored. **Your $20 deposit SECURES your child's spot. Your child's spot will not be saved with out the deposit payment.
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 13th. 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/CFT 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, / Capoeira for Tomorrow, 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!
Emergency Care Waiver *
I hereby give my consent to Cpoeira Brazilian Pelourinho, Inc, / Capoeira For Tomorrow, Inc. it's 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.
Liability Waiver Release - Terms & Conditions *
In consideration of being permitted to participate in any way in a Capoeira Brazilian Pelourinho also referred to as "CBP" and Capoeira For Tomorrow, Inc. also referred to as "CFT" programs as indicated below and/or being permitted to enter for any purpose any restricted area (herein defined as any area wherein 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, CBP/CFT 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 CBP/CFT, 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/CFT, 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/CFT 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 vehicle.6) In the event of a serious accident or illness, I request that CBP/CFT 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/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 understand that CBP/CFT 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 CBP/CFT. 8) There are no expectations of childcare. CBP/CFT is a martial arts school and not a daycare in as such, their stock and trade is not supervision and care. The intent of CBP/CFT is to teach martial arts and physical and philosophical character building skills. 9) I, the enrollee or the member, irrevocably authorize CBP/CFT 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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