A Journey to Brazil Summer Camp 2019
Join us at the ArteLuta Capoeira Academy in Lomita, CA for a dynamic and fun-filled exploration of Brazil, one of the most diverse and spectacularly beautiful countries in South America.

Designed for youth ages 5-10 years old, “A Journey to Brazil” will immerse campers in the arts, culture, language, music and national sports of Brazil.

Email address *
Camper's Name: *
Your answer
Camper's Date of Birth: *
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Which Session: *
Required
Camper's T-shirt Size: *
1. Parent or Guardian's Name: *
Your answer
1. Parent or Guardian's Cell Phone Number: *
Your answer
2. Parent or Guardian's Name:
Your answer
2. Parent or Guardian's Cell Phone Number:
Your answer
3. Name of Emergency Contact (in case parents are not available): *
Your answer
3. Emergency Contact Cell Phone Number: *
Your answer
List any injuries or allergies (food or otherwise) your child has that we should be aware of: *
Your answer
Is anyone besides the parents/guardians listed above authorized to pick up your child? *
If yes, list the name of any additional people authorized to pick up your child and their relationship to your child:
Your answer
What would like us to know about your child? *
Your answer
Before or After Care
Each session our camp is offered from 9:00 am until 2:00 pm. If necessary, we can provide before/after care for an additional fee ($10 per ½ hour), starting as early as 8am, and going as late as 3pm.

Before/After care is supervised and unstructured. Children are encouraged to bring books, practice what they have been learning and/or continue working on their art projects.

Will your child need before or after care? *
If yes, which days and times?
Your answer
Summer Camp Waiver/ Participant Release
As legal parent/guardian(s), I/We hereby give the child listed above our permission to participate in ArteLuta Capoeira’s summer programming including classes, workshops and all indoor and outdoor sports, and related activities. In consideration of our child’s right to participate in ArteLuta Capoeira’s activities, I/We hereby waive, release and discharge any and all rights or claims against ArteLuta Capoeira, their respective employees, members and independent contractors as a result of our child’s participation in its program. Further, I/We agree to defend, indemnify and hold ArteLuta Capoeira harmless against any and all claims, actions or suits which may be brought as a result of damages or losses sustained as a result of participation in ArteLuta Capoeira’s program.

In the event of a serious accident or illness, I/We request that ArteLuta Capoeira contact me. If I/We cannot be reached, I/We authorize you to 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/We 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 ArteLuta Capoeira, I/We request that you attempt to contact me first at the numbers that I/We have provided to arrange transportation for my child. In the event that I/We cannot be reached, please contact the emergency contact I have listed.

Click Yes to indicate that you have read, understand and agree to our 2019 summer camp waiver/release. *
Summer Camp Photo/Media Release
I understand that ArteLuta Capoeira may wish to use photographs of my child for published promotional medium or otherwise. I hereby consent and give ArteLuta Capoeira permission to take photographs and/or digital video images of my child and to use and publish such photographs, together with any caption or descriptive material, for advertising, publicity, or any other purposes in ArteLuta Capoeira’s promotional medium, or in any other publication or manner that ArteLuta Capoeira may authorize.I waive the right to inspect or approve any photographs or digital video images before they are published and any use to which they may be put. I release ArteLuta Capoeira and its employees of and from all debts, claims and liability of any kind arising out of or in connection with the taking and use of photographs, the use of my name and the use of any caption or descriptive material therewith.
Click Yes to indicate that you have read, understand and agree to our 2019 summer camp photo/media release *
PAYMENT INFO
In order to confirm your child's spot in our summer camp, you must pay the registration fee as well.

Camp registration $200 (per session)
Before/ After Care $10 (per 1/2 hour)
Extra Camp T-shirt $20 (each camper will receive a t-shirt)

Payment can be made:

IN PERSON: using cash, check or credit card.
VIA VENMO: @varal10
VIA PAYPAL: https://www.paypal.me/ArteLutaCapoeira

Please note: there will be a 3% handling fee when using credit cards and PayPal.

Recommended Application and Registration Fee Deadline: Mon, June 3, 2019 by 5pm

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A copy of your responses will be emailed to the address you provided.
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