Summer Ninja Session
Registration Form
Email address *
Please select the session you will attend
Student's Last Name *
Your answer
Student's First Name *
Your answer
Age *
Your answer
Gender *
Address *
Your answer
Parent name *
Your answer
Parent Phone *
Your answer
Please list any allergies or medical conditions your child has *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Release, Waiver and Authorization
I confirm that my child enrolled in the Esperanza Del Rio Taekwondo (EDR TKD) Camp is current on all immunizations as mandated by the State of Texas. Permission is granted for full athletic participation in the camp. I understand I will be contacted in the event of an accident and/or injury. However in the event I cannot be reached, I consent to examination for adult instructors of the EDR TKD Camp to administer medications prescribed by a qualified physician. I also understand that neither Esperanza Del Rio, nor anyone connected with the EDR TKD Camp will assume any responsibility for accidents or sickness incurred by my child while at the EDR TKD Camp. I agree to assume sole responsibility for payment of any and all medical, dental, or other expenses incurred as a result of such sickness and/or injury.I, the undersigned, consent to allow Esperanza Del Rio Community Church (Esperanza) the use of my minor child/children’s voice, image, likeness, and any and all attributes of his/her/their personality in the photographs and video taken during EDR TKD Camp and the showcases. I hereby assign and authorize the Producer, and Esperanza the right (All Rights) to, without limitations, edit, reproduce, copy, exhibit-publish and distribute these photographs and video. I waive all rights or claims I might have against your organization and its staff. I further give permission to Esperanza to use my child’s name, and age in connection with any such uses of the photographs, video and sound recordings I represent and warrant that I am the parent or legal guardian of the below named minor child/children. I hereby consent to the foregoing on his/her behalf. This is completely voluntary by me. I understand that the instruction that will take place during this class/classes may require instructors to touch my child either in correction of technique or out of protection (i.e. spotting jumps and tumbling techniques) and consent to allow Esperanza Taekwondo staff to do so. *
A copy of your responses will be emailed to the address you provided.
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