CCIKA Summer Camp 2022

First Name *

Last Name *

Address

City

State

Zip

Gender *

Birth Date * +

Age *

Email *

Current Belt Color *

Summer Camp Date

CCIKA Summer Camp Dates *

June 13-17 (6 remaining)

July 11-15 (7 remaining)

August - 1-5 (15 remaining)

Summer Camp 2022 Fee *

$250 (Active members)

$300 (Active members after May 15)

$500 (New students + 1 month classes + uniform + membership)

Do you need Extended Care? (optional)

$75.00 (3pm - 6pm for the week)

Relationship to Participants: *

Parent/Guardian (under 18 yrs.)

Self (18 + yrs.)

Parent/Guardian Name *

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