International Tae Kwon Do Academy - Summer Sports and Fitness Camp
32 Tioga Way Marblehead, MA. (781) 631-8504 / www.tkd.net

2021 Schedule

Hours: 9:30 - 3:00 Mon - Fri.
*Students may attend whole or partial weeks. Please check availability.
Week #1: June 21 - 25 Week #5: July 19 - 23 Week #9: Aug. 16 - 20
Week #2: June 28 - July 2 Week #6: July 26 - July 30 Week #10: Aug. 23-27
Week #3: July 5 - 9 Week #7: Aug. 2 - 6 Back to School
Week #4: July 12 - 16 Week #8: Aug. 9 - 15 Fall classes resume


Name _______________________________________________________ Date of birth ____/____/____

Address ____________________________________City_________________________________________

Phone #s _____(________)_______________________     ______(_________)_________________________

General Health: (please check) Excellent _______ Good _______ Fair _______ Poor________

Are you Allergic to bees? Yes ___ No ___ Donít Know ___ (If yes, please bring a bee sting kit.)

Any medical problems? Yes ___ No ___ Are you taking medications? Yes ____ No ____

If yes, then please explain? _______________________________________________________________

The above named student would like to enroll in the weeks indicated below.

Please indicate the dates or weeks you want: ___________________________________________________________________________________________
If these weeks are not available, please return my deposit ___
If these weeks are not available, please put me on a waiting list ___
If these weeks are not available, please contact me about other possibilities ___

Cost of a full week: $300 X _____ (#of weeks) = $__________

Cost of 3 days/week: $195 X _____ (#of weeks) = $__________

Cost of 2 days/week: $135 X _____ (#of weeks) = $__________

Cost of 1 day/week: $70 X _____ (#of days ) = $__________

Special offer: Save $5/day any 15 days.
[Example: 3 full weeks or 15 random days]

Deposit paid: $50 per week or partial week = $__________

Balance Due: = $__________         (______)   check here if you have paid on-line

Checks may be made payable to either International Tae Kwon Do Academy or to Brian Malik

Release and waiver of liability:
I understand that there are risks involved when children practice and play games. Therefore, I releases the International Tae Kwon Do Academy, it's instructors and students, from liability for any loss or suffering, which may occur in the course of instruction or activities.


_____________________________________________   _______/_______/_______
Parent's Signature and date

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