SUMMER CAMP 2004 WAIVER I know that participating in the World Tae Kwon Do Association (WTA) and Tae Han Karate Assoc. Inc. (THKA), exercise and training summer camp classes is a potentially hazardous activity. I agree not to enter and participate unless I am medically able. I am voluntarily entering and assuming all risks associated with participating in the events, including but not limited to falls, contacts with other participants, the effects of weather including heat and or humidity, and the conditions of the training grounds and facilities, all risks being known and appreciated by me. Having read this waiver, and knowing these facts, and in consideration of your acceptance of this application, I, for myself and anyone entitled to act on my behalf, waive and release the WTA and THKA and it’s representatives from all claims and liabilities of any kind arising out of my participation in this event or related activities. ____________________ Signature (parent or guardian if under 18) ____________________ Dated Grandmaster Duk Sung Son 14th Annual Summer Camp August 5 - 8, 2004 Storm King School- Cornwall, NY REGISTRATION FORM Space is limited and registrations are accepted on a first come first served basis_ NAME LAST FIRST MIDDLE RANK CERTIFICATE # INSTRUCTOR AGE GENDER M- F ADDRESS TELEPHONE# EMAIL PAYMENT NORTHEAST REGION ____ $200 (By 3/15/2004) non refundable date paid ______________chk#_______ ____ $200 (By 6/15/2004) Final* ________date paid_______________ chk#_______ ____ $400 (Single payment option)_______date paid_______________ chk#_______ OUTSIDE NORTHEAST REGION ____$175 (By 3/15/2004) non refundable date paid ______________chk#_______ ____$175 (By 6/15/2004) Final* date paid ______________chk#_______ ____$350 (Single payment option date paid ______________chk#_______ * If your second payment is not received on time your deposit will be forfeited and your space will be given to someone on the waiting list.