subject_line
CCIKA Summer Camp 2022
First Name
*
Last Name
*
Address
City
State
Zip
Gender
*
Female
Male
Birth Date
*
+
Age
*
Phone
*
Email
*
Days
CCIKA Summer Camp Dates
*
June 13-17
(0 remaining)
July 11-15
(0 remaining)
August - 1-5
(2 remaining)
Summer Camp Fee
Summer Camp 2022 Fee
*
$250 (Active members)
$300 (Active members after May 15)
$500 (New students + 1 month classes + uniform + membership)
Campers Extended Care
Do you need Extended Care? (optional)
$75.00 (3pm - 6pm for the week)
Student / Adult Contact
Relationship to Participants:
*
Parent/Guardian (under 18 yrs.)
Self (18 + yrs.)
Parent/Guardian Name
*
Chief Instructor: Grandmaster/Hanshi James Carter
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