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2024 ACDKL Summer Camp

Kickin’ in the Woods

Summer Camp Info PDF

Registration Notes

Registration fees will cover
- all meals from dinner on Friday to breakfast on Sunday
- Camp t-shirt
- lodging fees
If you have any dietary restrictions or special needs, please make sure to state those in the form below and we will do our best to accommodate those needs.
If you have any questions about registration, please contact Master Kate Hanson at kate@pkhanson.com.

Name of Participant

First Name

Last Name

Age of participant

T-shirt Size

These are all Unisex sizes

Name of Parent/Guardian if participant is a minor

First Name

Last Name

Phone Number

(###)

###

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Club Information

Taekwondo School

If you selected "Other" for your Taekwondo school, please give the name of your school, and the city and state in which the school is located.

Taekwondo Belt Rank of Participant

Medical Information

Medical/Mental/Physical Concerns

If the participant has any medical concerns or limitations that may be of a concern for this camp, or if they have any mental/physical concerns you would like the camp staff and volunteers to be made aware of, please list those below. This includes any allergies and/or medications that the participant may be taking while at camp. If there is no concerns, please type N/A.

Food allergies/sensitivities/restrictions

Please list any food allergies, sensitivities, restrictions, or preferences such as vegetarian. If the participant carries an Epipen for these allergies, please make sure to state that in the previous medical questions field. If the participant has no food restrictions, please type N/A.

Emergency Contact Information

Emergency Contact Phone Number

Please list a phone number of the emergency contact that can be reached at all times of the day in case of an emergency.

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact Relation to Participant

Photo Posting Permission

There will be photos taken throughout the entirety of the Summer Camp. If you have any conerns about this, please contact Kate Hanson at kate@pkhanson.com. If you select to not give your permission, the participant will have their face and any visible name blurred or removed before photos are posted.

Permission for Photo Sharing

I give permission to the American Chung Do Kwan Limited Association, the Boys and Girls Club of Story County, all participating Taekwondo Clubs, and Camp Sacajawea to post pictures of the participant on social media and on any future literature to promote future summer camps or organization sponsored events.

Yes, I give my permission to all stated organizations to post pictures of the participant.

No, I do not give my permission to all stated organizations to post pictures of the participant.

Permission to Participate (same as ACDKL registration form)

I understand that Tae Kwon Do is a martial art requiring physical contact and strenuous physical exercise. I hereby release and agree to indemnify and hold harmless the American Chung Do Kwan, Ltd., its' officers, masters, instructors, black belt members, judges, officials, student members, and other students as well, and Boys and GIrls Club of Story County Dragon Taekwondo Club from any and all claims arising as a result of or in connection with the martial arts training, promotion testing, summer camp, or competition, including transportation to and from such events sponsored or sanctioned by the American Chung Do Kwan, Ltd., Boys and GIrls Club of Story County Dragon Taekwondo Club, also known as BGCSC Dragon TKD, or in which the American Chung Do Kwan, Ltd. is participating. I affirm that the confidential medical information that has been provided is accurate and complete. I understand that failure to disclose this information could affect my own safety and those around me, and I agree to hold BGCSC Dragon TKD Instructors and American Chung Do Kwan Limited harmless if full disclosure of a pre-existing medical condition has not been provided. In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization or other treatment that may become necessary. I understand that parts of the martial arts program may be physically or emotionally demanding. I hereby acknowledge that I am aware of these risks and I agree to follow all safety instructions and ask questions if I do not understand. I also acknowledge that, despite careful precautions, there are certain inherent risks of injury in this program, and I accept those risks. I understand that each participant must assume the risk of injury or disability that could result from any of the activities. I release, on behalf of my heirs and assigns, BGCSC Dragon TKD Instructors, and American Chung Do Kwan Limited, its employees and successors, from and against any and all claims and causes of action arising out of my participation in this program, except insofar as such claim or cause of action arises from the actual negligence or intentional acts by BGCSC Dragon TKD Instructors, or American Chung Do Kwan Limited, its officers, agents or employees. I have read and I understand this statement. Type your name below to agree to the above statements as your permission for your child or self to participate in the ACDKL 2024 Summer Camp.