Summer Camp Waiver and Registration - Oliver Martial Arts Academy

Liability Waiver & Release

The undersigned, being the parent/legal guardian of the above-named camper/student, hereby requests permission for the student to participate in Oliver Martial Arts Academy – Riverview (OMA) Karate / Martial Arts Summer Camp activities.

I hereby release, waive, discharge, and covenant not to sue Oliver Martial Arts Academy – Riverview, including its owners, family members, facilitators, officers, instructors, employees, volunteers, and agents (collectively referred to as “Providers”), from any and all liability, claims, demands, actions, causes of action, damages, costs, or expenses arising from participation in Summer Camp activities.

This includes, but is not limited to:

Personal injury, disability, or property damage
Illness or infection, including SARS-CoV-2 (COVID-19)
Accidents, death, or any loss caused by negligence or otherwise

I fully understand and acknowledge the risks associated with participation in Summer Camp activities.

Parent/Guardian Signature *

Sign here with mouse or finger

Date *

Policies – Please Read & Initial Each Section

Photo & Video Release

Photos and/or video footage of classes, activities, or field trips may be used by Oliver Martial Arts Academy – Riverview for promotional purposes.

I hereby grant permission for photographs and/or videos to be taken of my child while participating in Summer Camp activities.

Parent/Guardian Initials:

Indemnification Agreement *

I agree to indemnify and hold harmless OMA and all Summer Camp Providers from any liability, loss, damage, or cost incurred while my child participates in Summer Camp activities.

Parent/Guardian Initials:

Camp Registration & Refund Policy *

When you select specific camp weeks or days, those dates are reserved for your child. Due to limited space, we cannot switch or cancel reserved weeks/days.

ALL PAYMENTS ARE NON-REFUNDABLE for any reason, including but not limited to: Absences, Illness, COVID-19, Hurricanes, Emergencies, or situations outside of OMA’s control.

Parent/Guardian Initials:

Electronics Policy *

Participants may bring electronics such as: Nintendo Switch, Tablets/iPads, Laptops, Video games, DS devices, or iPods.

Electronics may only be used: 1 hour in the morning (8–9 am) and/or 1 hour in the afternoon (5–6 pm).

OMA is NOT responsible for lost, stolen, or damaged electronics or personal items. NO sharing electronics.

Parent/Guardian Initials:

Cell Phone Policy *

If your child brings a cell phone, all electronics will remain on AIRPLANE MODE from 9:00 AM – 5:00 PM.

If you need to contact your child during camp hours, please text or call OMA Staff at: 813-897-3476.

Parent/Guardian Initials:

Movie Theater Policy *

OMA plans to take campers to the movie theater once per week. This fee is INCLUDED in the weekly tuition.

Please do NOT send cash or extra food/snacks for the theater. Children may bring a small blanket. On movie days, we leave the academy at 8:45 AM, SHARP.

Parent/Guardian Initials:

Weekly Field Trips *

OMA plans weekly field trips, which will be announced one week in advance through email. Please check your email regularly for updates and notifications.

Parent/Guardian Initials:

Summer Camp Dress Code *

Field Trip Days (Thursday & Friday): Campers MUST wear their OMA shirt.

Park & Activity Days: Socks and closed-toe tennis shoes are REQUIRED.

Appropriate Clothing: No extremely short shorts, no crop tops or belly-showing shirts, no inappropriate graphics or wording on clothing. OMA reserves the right to request a change of clothing.

Parent/Guardian Initials:

Outdoor Activities *

We plan to spend as much time outdoors as weather permits and expect to visit parks multiple times per week.

Campers should bring DAILY: Water bottle, Hat, Packed lunch, Spray sunscreen (minimum SPF 45), Socks & tennis shoes, Extra snack if staying for karate classes.

Parent/Guardian Initials:

Water Bottle Policy *

If a camper does not bring a water bottle, OMA will provide one for $1.00. Hydration is REQUIRED.

Parent/Guardian Initials:

Camp Hours & Late Pick-Up Fees *

Summer Camp Hours: 7:30 AM – 6:30 PM

Late Pick-Up Fees: $1.00 per minute starting at 6:31 PM.

Parent/Guardian Initials:

Summer Camp Price List *

Item	Price
Registration Fee – New Camper	$60.00
Registration Fee – Returning Camper (waived, subject to OMA verification)	$0.00
Weekly Tuition – Full Week (Mon–Fri)	$215 / week
Daily Rate	$50 / day
OMA Dry Fit Shirt (additional, if needed)	$18.00

Parent/Guardian Initials:

Lunch, Snacks & Personal Items *

Children MUST bring a packed lunch daily. OMA cannot leave camp to purchase food, provide extra lunches, or guarantee time to call parents during lunch.

Children may bring additional snacks from home for morning or afternoon. Campers ages 5–6 may keep an extra change of clothes in their cubby. Campers may bring books, games, or toys, but are fully responsible for their belongings.

Parent/Guardian Initials:

Medical Information

Illness & Pickup Policy *

If my child becomes ill, develops a cough, vomiting, pink eye, diarrhea, a fever of 99°F or higher, or any other symptoms of illness, I agree to pick up my child within 30 minutes of notification by OMA staff.

Parent/Guardian Initials:

Health & Vital Information

Current Medications (or write “None”) Allergies / Reactions (or write “None”) Food Restrictions (or write “None”) Chronic / Acute Illnesses (or write “None”)

Emergency Medical Authorization: I understand that every effort will be made to contact me before medical treatment is authorized for my child.

Parent/Guardian Initials:

Physician Information

Student’s Physician Name Physician Phone Number Preferred Hospital

Parent / Guardian & Authorized Pick-Up

Parent / Guardian Information

Parent/Guardian Full Name *

Work Phone

Cell Phone *

Email Address *

OMA communicates important updates primarily through email.

Home Address *

City *

ZIP Code *

Authorized Pick-Up Persons

The following individuals are authorized to pick up my child. A valid photo ID will be required at pickup.

Authorized Person #1

Full Name *

Relationship

Phone

Emergency Contact?

Yes No

Authorized Person #2

Full Name

Relationship

Phone

Emergency Contact?

Yes No

Authorized Person #3

Full Name

Relationship

Phone

Emergency Contact?

Yes No

Payment Authorization & Consent

Payment Due Dates *

Summer Camp payments are due on the Friday before the week of service, or no later than Monday of that camp week.

Beginning on Tuesday, payments are considered LATE and a late fee of $10.00 per day will be added for each late day.

ALL MONEY PAID IS NON-REFUNDABLE

Parent/Guardian Initials:

Preferred Payment Method *

Indicate how you plan to make Summer Camp payments. Payment is due the Friday before each camp week.

I plan to pay with: *

Cash
Please bring cash payment to the Oliver Martial Arts Academy office. Credit Card / Debit Card
A staff member will contact you to arrange secure payment.

Payment Reminder: Payments are due the Friday before the week of service, or no later than Monday of that camp week. Beginning Tuesday, a $10.00/day late fee applies.

Parental Consent (COPPA) *

I confirm I am the child’s parent or legal guardian and am at least 18 years of age. I consent to the collection and use of my child’s information for registration and safety purposes per our Children’s Privacy Policy. I may revoke consent at any time by contacting oma@omakarate.com.

Campers must bring a packed lunch, water bottle, hat, and closed-toe tennis shoes every day.

Review Your Information

Please review your information below. Use the Edit buttons to return to any section and make corrections before submitting.

Acknowledgment & Final Signature

Acknowledgment & Signature

I certify that I have fully read, understood, and agree to all terms and conditions outlined in this Summer Camp Waiver & Registration Form.

Parent/Guardian Name (Print) * Parent/Guardian Signature *

Sign here with mouse or finger

Date *

I confirm that I have read and agree to all policies, waivers, and terms in this registration form. I understand that all payments are non-refundable and that I am responsible for following all OMA Summer Camp rules and guidelines.

✓

Registration Submitted

Thank you for registering for OMA Summer Camp 2026. We will review your form and contact you at the email provided to confirm your registration and payment details.

Questions? Call or text us at 813-897-3476

Confirmation Number —

Oliver Martial Arts Academy – Riverview | www.omakarate.com

Oliver Martial Arts Academy – Riverview

Attendance Type *

Camper / Student Information

How Did You Hear About Us? *

Liability Waiver & Release

Photo & Video Release

Indemnification Agreement *

Camp Registration & Refund Policy *

Electronics Policy *

Cell Phone Policy *

Movie Theater Policy *

Weekly Field Trips *

Summer Camp Dress Code *

Outdoor Activities *

Water Bottle Policy *

Camp Hours & Late Pick-Up Fees *

Summer Camp Price List *

Lunch, Snacks & Personal Items *

Illness & Pickup Policy *

Health & Vital Information

Physician Information

Parent / Guardian Information

Authorized Pick-Up Persons

Authorized Person #1

Authorized Person #2

Authorized Person #3

Payment Due Dates *

Preferred Payment Method *

Parental Consent (COPPA) *

Acknowledgment & Signature

Registration Submitted

Oliver Martial Arts Academy

Company

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