Han's White Tiger Tae Kwon Do Summer Camp Registration
June 3rd through August 2nd, 2024

Han's White Tiger Tae Kwon Do
7340 Yankee Road
Liberty Township, OH 45044
513-777-5700

8177 Princeton Glendale Road
West Chester, OH 45069
513-553-5700


***Registration Fees, Weekly Tuition and Field Trip fees must be paid in person at either the Liberty or West Chester locations via cash or check only.
Email *
Parent/Legal Guardian First Name *
Parent/Legal Guardian Last Name *
Parent/Legal Guardian #1 Phone Number (Including Area Code) *
Parent/Legal Guardian #1 Email Address *
Parent/Legal Guardian #2 First Name *
Parent/Legal Guardian #2 Last Name *
Parent/Legal Guardian #2 Phone Number (Including Area Code) *
Parent/Legal Guardian #2 Email Address *
Street Address *
City *
State *
Zip Code *

Summer Camp Hours & Information: 

Summer Camp Registration Fees, weekly tuition and field trip fees may be paid at the front desk at either the West Chester or Liberty Township locations.  

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What days will you attend?

***If you are unsure of what days your student will attend a specific week, Han's White Tiger must be notified 7 days in advance.
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Monday
Tuesday
Wednesday
Thursday
Friday
My student will NOT be attending camp this week.
I am unsure of the dates my student will attend.
Week 1: 6/3/24 - 6/7/24
Week 2: 6/10/24 - 6/14/24
Week 3: 6/17/24 - 6/21/24
Week 4: 6/24/24 - 6/28/24
Week 5: NO SUMMER CAMP
Week 6: 7/8/24 - 7/12/24
Week 7: 7/15/24 - 7/19/24
Week 8: 7/22/24 - 7/26/24
Week 9: 7/29/24 - 8/2/24
Student #1 First Name *
Student #1 Last Name *
Student #1 Date of Birth *
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Student #1 T-Shirt Size *
Student #2 First Name

***If not enrolling a 2nd student, please type N/A in the field below.
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Student #2 Last Name

***If not enrolling a 2nd student, please type N/A in the field below.
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Student #2 Date of Birth
MM
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DD
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YYYY
Student #2 T-Shirt Size *
Emergency Contact #1:  Please provide the name of your first emergency contact.  This MUST be a different name than either of the above Legal Guardians.   *
Emergency Contact Relationship *
Emergency Contact #1 Phone Number (including area code) *
Emergency Contact #2:  Please provide the name of your second emergency contact.  This MUST be a different name than either of the above Legal Guardians.   *
Emergency Contact #2 Phone Number (including area code) *
Emergency Contact Relationship *
Pediatrician/Primary Care Physician Name
Pediatrician/Primary Care Physician Address (Street Address, City, State, Zip Code)
Pediatrician/Primary Care Phone Number (Including area code)
Student #1 Health History *
Student #1 Health History - Please list all other chronic/serious illnesses your child may have.   *
Student #1 Immunizations *
Required
Student #1 Allergies

If your childs' allergy is not listed, please provide information in the "other" field.
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If you child has allergies, please describe what type of reaction your child has and what interventions need to be made in the event of exposure to that allergen.
Student #1 Dietary Restrictions

Please advise if there are any allergies or food restrictions that we should be aware of.  If one is not listed, please add that information in the "other" field.
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Student #1 Physical Restrictions/Limitations *
Required
Student #1 Physical Restrictions/Limitations

If your child has physical restrictions/limitations, please provide that information in detail.
Student #1 Prescription & Non-Prescription Medications Please list any medications your child may be bringing to camp.  

All prescription medications must be in the original container with the students name, date of birth, prescribing physician and dosing instructions.  If your child needs to be administered medication during the course of summer camp, specific written instructions must be provided by the parent/legal guardian.  

Please also check the below boxes to include what over the counter (OTC) medications may be administered to your child during the course of summer camp.  OTC medications must be provided by the parent/legal guardian and must include written instructions, the reasons in which a medication is allowed to be administered & the dosage that is to be administered.

***Han's White Tiger will NOT administer any medication without all of the above information.

All necessary equipment must be provided by the parent/legal guardian (inhaler spacers, syringes for liquid medications, cold case for Epipen, etc)
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Required
Student #1 Health History

This health history record is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted by me.  I also attest that the person herein described has had a medical examination within the past 24 months.


I understand and certify that my child’s participation in the summer camp program is completely voluntary. I understand that while Han’s White Tiger Tae Kwon Do makes every effort to provide a safe environment for my child, accidents do occasionally happen. I hereby give Han’s White Tiger Tae Kwon Do permission to have my child transported and treated by the nearest hospital or physician. Furthermore, I have instructed my child in the importance of abiding by the camp’s rules and procedures for the safety of camp participants.

 

I understand that parents are contacted in the event their child receives professional medical attention. In the event that I cannot be reached in an EMERGENCY, I hereby give permission to the attending physician secured by Han’s White Tiger Tae Kwon Do to hospitalize and secure proper treatment for my child.

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Required
Student #2 Health History *
Student #2 Health History - Please list all other chronic/serious illnesses your child may have.  If none (or if you are not enrolling a 2nd student in camp), please type N/A. *
Student #2 Immunizations *
Required
Student #2 Allergies

If your childs' allergy is not listed, please provide information in the "other" field.
 *
If you child has allergies, please describe what type of reaction your child has and what interventions need to be made in the event of exposure to that allergen.  

***If you are not enrolling a 2nd student, please type N/A in the field below.
 *
Student #2 Dietary Restrictions

Please advise if there are any allergies or food restrictions that we should be aware of.  If one is not listed, please add that information in the "other" field.
 *
Student #2 Physical Restrictions/Limitations *
Required
Student #2 Physical Restrictions/Limitations

If your child has physical restrictions/limitations, please provide that information in detail.

***If you are not enrolling a 2nd student, please type N/A in the field below.
 *
Student #2 Prescription & Non-Prescription Medications Please list any medications your child may be bringing to camp.  

All prescription medications must be in the original container with the students name, date of birth, prescribing physician and dosing instructions.  If your child needs to be administered medication during the course of summer camp, specific written instructions must be provided by the parent/legal guardian.  

Please also check the below boxes to include what over the counter (OTC) medications may be administered to your child during the course of summer camp.  OTC medications must be provided by the parent/legal guardian and must include written instructions, the reasons in which a medication is allowed to be administered & the dosage that is to be administered.

All necessary equipment must be provided by the parent/legal guardian (inhaler spacers, syringes for liquid medications, cold case for Epipen, etc)
 *
Required
Student #2 Health History

This health history record is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted by me.  I also attest that the person herein described has had a medical examination within the past 24 months.


I understand and certify that my child’s participation in the summer camp program is completely voluntary. I understand that while Han’s White Tiger Tae Kwon Do makes every effort to provide a safe environment for my child, accidents do occasionally happen. I hereby give Han’s White Tiger Tae Kwon Do permission to have my child transported and treated by the nearest hospital or physician. Furthermore, I have instructed my child in the importance of abiding by the camp’s rules and procedures for the safety of camp participants.

 

I understand that parents are contacted in the event their child receives professional medical attention. In the event that I cannot be reached in an EMERGENCY, I hereby give permission to the attending physician secured by Han’s White Tiger Tae Kwon Do to hospitalize and secure proper treatment for my child.

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Required

Morning Drop-Off

Morning drop-off is available between 7am-8am.  We ask that all students be here no later than 8am so students can participate in all activities and also be on time for our field trips.  If a drop-off must occur after 8am, parents/legal guardians must notify Han's White Tiger the week before.  

If late drop-off occurs on a field trip or park day, we may ask that parents/legal guardians drop their child off directly to the field trip or park location rather than at Han's White Tiger so that we are not delayed getting the remaining campers to our destination.  If a parent/legal guardian is unable to bring a camper to the field trip destination, the camper will not be able to attend camp that day.  Any associated fees will NOT be refunded.

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Child Pick-Up

Anyone picking up your child will need to present a photo ID daily to camp staff for release of your child.  We will not release your child unless proper identification is given.  Please list persons authorized (other than parent/legal guardian) to pick up your child.  If those persons authorized are different than your emergency contact names, please provide phone numbers as well.

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Required

Field Trip Permission Form & Transportation Requirements

I hereby grant permission for my child to be transported by Han’s White Tiger Tae Kwon Do staff for activities, including parks, library, and field trips.  I understand that notice of such outings will be provided prior to any trip.  As long as weather cooperates, students my be transported to local parks for some outdoor time.  In case of a medical emergency, I understand that every effort will be made to contact me or my emergency contact.  If I, or someone on the emergency form, cannot be reached, I give Han’s White Tiger permission to secure the medical treatment necessary for my child; including hospitalization.  


Students will be transported by Han's White Tiger staff members.  If a student requires a car seat, parents/legal guardians must drop off a car seat with their student during AM drop-off.  In the event a car seat is not provided, it is assumed that your student can legally ride in a vehicle with a standard seat belt.  Han's White Tiger Tae Kwon Do will not be held liable for any incident in which proper seating is not provided by a parent/legal guardian.  

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Required

Media Release (Parent’s Permission) Form

Photographs/ Videos of Students in Han’s White Tiger Activities

I give permission for the above person(s) to be photographed in any Han’s White Tiger activities. I understand that these photographs may be used for information purpose within Han’s White Tiger programs and activities to the public through displays, advertisements, newspapers, and other print media, on television, and in connection with Han’s White Tiger information provided on the internet and the Han’s White Tiger Tae Kwon Do website.

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Required

Han's White Tiger Sick Policy

1. Please call us no later than 8:00 am if your child will not attend the Han’s White Tiger Summer Camp Program for any reason, especially due to illness.  Due to field trips and outings, we  need to know if your child will not be in attendance.
***I understand that absences due to illness will not be considered a reason for Han’s White Tiger to provide refunds or make up days.

 2. Unless otherwise instructed by a healthcare provider, children running a fever of 100 degrees or greater should remain at home.  Students may not return to summer camp until they have been fever free for at least 24 hours.

 3. Students who experience vomiting or diarrhea will not be permitted to attend summer camp.  Students should remain home until they have been free from vomiting or diarrhea for a minimum of 24 hours.

 4. If your child has acquired a contagious disease including but not limited to Covid-19, Flu, Impetigo, Lice or Scabies, parents/legal guardians are required to notify Han’s White Tiger Tae Kwon Do as soon as possible.  Please be advised that Han's White Tiger will be required to notify any other students and families who may have been exposed.  To protect privacy, the identification of the original student will be kept confidential.

 5. Children who have had a communicable disease may not return to the program unless they have a doctor’s note stating that they are no longer contagious.

 6. If Han’s White Tiger staff feels that a child is not well, or has a fever of 100 degrees or higher, parents will be called and asked to pick their child up.  You must make arrangements to pick up your child as soon as possible.

 

***Covid-19 Addendum

1.     Students are not required to wear a mask to attend camp.  Please note that Covid-19 protocols are subject to change at any time.

2.     Students who test positive for Covid-19 must abide by all State of Ohio guidelines regarding quarantine.  Students may not return to camp unless their quarantine has been lifted.  Once a quarantine has been lifted, students must wear a mask for the next 5 days per State of Ohio guidelines.  If a potential exposure has occurred to other Han’s White Tiger students, families must immediately notify Han’s White Tiger of the potential exposure. 

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Required
Han's White Tiger Summer Camp Behavior Agreement *
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Summer Camp Waiver & Agreement

All waivers & agreements MUST be signed/initialed in order for this application to be processed.  No changes to the waivers & agreements will be accepted.  

PLEASE READ CAREFULLY.

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I agree to waive any and all claims against any person or persons connected with Han’s White Tiger Tae Kwon Do, LLC.


This Registration Form will also serve as permission for Han’s White Tiger Tae Kwon Do, LLC to provide the above named student with any and all emergency medical attention needed if the situation should arise, including, but not limited to, band aids, icepacks, CPR, etc.

Han’s White Tiger Tae Kwon Do is committed to conducting its programs and activities in the safest manner possible and holds the safety of participants in the highest possible regard.  Participants and parents registering their children in programs and activities must recognize, however, that there is an inherent risk of injury when choosing to participate.  Han’s White Tiger Tae Kwon Do strives to reduce the risks and insists that all participants follow safety rules and instructions, which have been designed to protect the participant’s safety. If your child does become injured, Han’s White Tiger Tae Kwon Do has your permission to have your child transported and treated by the nearest hospital or physician.

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Required
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