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WCKFC
SUMMER
CAMP
329 N. State Steet
Orem, UT 84057
NAME:____________________________, AGE:____, SCHOOL
(if presently a WCKFC student):________________
PHONE #_______________________, EMAIL:_______________________________________________________
ADDRESS: ___________________________, CITY:________________________, STATE:______, ZIP:________
CHECK: male ____ female ____. CIRCLE SHIRT SIZE: S M L XL XXL (add $2.00) XXXL (add $2.00)
NOTE: Camp fees must be paid in full before camp starting date or your student position at the camp will be forfeited.
| ITEM | COST | AMOUNT SUBMITTED | |
| Student Camp fee paid in full (WCKFC/WCICAA Member) | $190 | ||
| Non-Member fee paid in full | $380 | ||
| 50% deposit sent with application | ------- | ||
| 50% balance (due by August 1st) | ------- | ||
| Dit Da Jow ($12.00 each) | $12 | Qty: | |
| Extra Camp T-Shirt (XXL & XXXL is $2.00 extra) | $18 | Qty: | |
| Summer Camp Picture CD (sent to you at the conclusion of the Camp) | $16 | Qty: | |
| Summer Camp Group Picture (sent to you at the conclusion of the Camp) | $5 | Qty: | |
| TOTAL AMOUNT SUBMITTED
WITH THIS APPLICATION Checks must be payable to Carlos Colorado |
------- | ||
Student must be 16 or older unless special permission is received from the
camp director. Student represents
that he/she is physically sound
and that he/she has medical approval to proceed with a rigorous routine of
exercise. The student
acknowledges the existence of certain risks of personal injury in
participating in the course of instruction and that he/she is assuming this
risk freely and voluntarily and without liability to the Wing Chun Kung Fu
Council/Ving Tsun Ip Ching Athletic Association and/or its representatives.
All fees are non-refundable.
_____________________________________________________________________
STUDENT SIGNATURE AND DATE (If under 18, parent or guardian signature)