Camp Panama 2013 - Hosted by DSKA (Karate Event)

2727 thth International Camp & ChampionshipInternational Camp & Championship March 10 – 17, 2013

The Most Dynamic and Technical Camp

The Most Innovative Applications of Katas

Special Kumite Training for Competition

Judges and Referees Workshop

Professionally Organized Tournaments

High Level Tournament Officials

281-499-1313 [email protected]

347-327-4421 832-715-8341

[email protected] [email protected]

WWW.DSKA.ORG

International Instructor

Hanshi Ricardo W Johns

9th Dan

High Dan participation

All ages

Camp Panamá 201320132013

Enjoy the Beautiful Country of Enjoy the Beautiful Country of PanamáPanamá

High level competition

<< Dai-Ichi Shotokan Karate-Do >>

Spring Camp/Tournament 10th – 17th March 2013

PANAMA CITY, PANAMA

Come and enjoy Panama!! Enjoy the sights of Panama and its exciting, shopping, and dining places. Discover the wonder of the Panama Canal and witness history in making with the work being done to expand the canal. Enjoy the sights of old Panama and its history, Palacio de las Garzas the official residence of the President of Panama. Enjoy shopping at the malls, spend 2 nights 3 days at an all-inclusive beach resort and much more!

Paradise is found!

8 day / 7 night packages start from

$360-$650

Packages Include:

• Camp Fee • Transportation • 2 nights/3 days all inclusive beach resort • Tours • Farewell Banquet

Conditions: Prices subject to change. Prices include taxes. First deposit October 1, 2012. Final Balance is due 30 days prior to departure. Recommendations: Reserve Early! For information contact: Shihan Kareemah Johns Please note airfare and 5nights stay at Torres de Alba Hotel in Panama City not included

281-499-1313 E-mail [email protected], [email protected]

SPRING CAMP PANAMA 2013 PACKAGES

Package # 1- Adult (12 and above) Participants This Package Includes the Following:

Transportation Fee: • To and From Tocumen International Airport • To and From Decameron all Inclusive resort • To and From Tournament • All Tours, Etc.

Training Camp 2013 Fee 2 nights 3 days Decameron all Inclusive resort DSKA closing cultural banquet

Total $650.00 per Person Does not include airfare or Torres de Alba hotel fees

Package # 2- Children (5 thru 11) Participants This Package Includes the Following:


Training Camp 2013 Fee 2 nights 3 days Decameron all Inclusive resort DSKA closing cultural banquet


Package # 4- Children (5 thru 11) Non-Participants This Package Includes the Following:


2 nights 3 days Decameron all Inclusive resort DSKA closing cultural banquet


Package # 3- Adult (12 and above) Non Participants This Package Includes the Following:


2 nights 3 days Decameron all Inclusive resort DSKA closing cultural banquet


SPRING CAMP 2013 PANAMA

REGISTRATION Thank you for registering to attend the Dai‐Ichi Spring Camp and Tournament. We want to make the process as easy as possible. You will need to complete a separate registration form for each individual attending.

If you have any questions about registration, please call 281‐499‐1313 or 713‐478‐9051.

Full Name

First Name Last Name Address

Street Address Address Line 2 City State Postal Zip Code Phone Number E‐Mail Date of Birth

Nationality

SPRING CAMP REGISTRATION PACKAGE INFORMATION Please select the type of registration (s) you would like. (Please note that package is per person)

o Package # 1‐ Adult (12 and above) Camp Participant $650.00 o Package #2 – Child (5 thru 11) Camp Participant $540.00 o Package #3 – Adult (12 and above) Family member/Guest $490.00 o Package #4 – Child (5 thru 11) Family member/Guest $360.00

Resort Information Please list all names and ages of all persons rooming with you Name__________________________________________________ Age________ Name__________________________________________________ Age________ Name__________________________________________________ Age________ Name__________________________________________________ Age________ Hotel Information Hotel Torres De Alba Check‐in date 03/12/2013 Rate: $99.00/per night double occupancy (breakfast and tax included) Number of persons in room ________ Name of person responsible for credit card payment Credit card number Passport number Deposit Information Note: Your credit card will not be charged. Once you check‐in to the hotel you will be responsible for payment at that time. Page 2

Spring Camp Registration cont. PAYMENT PLAN Package #1 Payment Number Due Date Amount 1 10/01/2012 $130.00 2 11/01/2012 $130.00 3 12/01/2012 $130.00 4 01/01/2013 $130.00 5 02/01/2013 $130.00 Package #2 Payment Number Due Date Amount 1 10/01/2012 $108.00 2 11/01/2012 $108.00 3 12/01/2012 $108.00 4 01/01/2013 $108.00 5 02/01/2013 $108.00 Package #3 Payment Number Due Date Amount Due 1 10/01/2012 $80.00 2 11/01/2012 $80.00 3 12/01/2012 $80.00 4 01/01/2013 $80.00 5 02/01/2013 $80.00 Package #4 Package Number Due Date Amount Due 1 10/01/2012 $72.00 2 11/01/2012 $72.00 3 12/01/2012 $72.00 4 01/01/2013 $72.00 5 02/01/2013 $72.00 Note: Package does not include hotel and airfare. All hotel reservations must be done through Dai‐Ichi Shotokan Karate‐Do camp coordinator in order to receive special rate. Once we receive your registration form we will contact the hotel and reserve your room. Once you get to the hotel you will make your payment. Please return pages 1& 2 with your payment Page 3

Please make payments to DAI‐ICHI, 2435‐G Texas Parkway, Missouri City, TX 77489Methods of Payments Cash, Certified Checks or Money Orders, Please No personal Checks.

DAI-ICHI SHOTOKAN KARATE-DO ASSOCIATION

Panama Spring Camp 2013

Medical History& Waiver

Name: (Please print) _____________________________________ DOB: _________________ Personal Physician: _____________________________ Office Number: ______________________

• Please complete all questions, if you have any condition that is not listed please indicate at the bottom. Explain all “yes” answers below: Yes No 1. Have you ever been hospitalized? [ ] [ ] 2. Have you ever had any type of surgeries? [ ] [ ] 3. Are you taking any medications? [ ] [ ] 4. Do you have any allergies to (bees, medicines, plants, or other insects)? [ ] [ ] 5. Have you ever or presently have high blood pressure? [ ] [ ] 6. Have you ever passed out during or after exercises? [ ] [ ] 7. Have you ever been told you have a heart murmur? [ ] [ ] 8. Have anyone of your family died of heart problems or sudden death

before age 50? [ ] [ ] 9. Have you ever had seizures? [ ] [ ] 10. Have you ever passed out or been dizzy in the heat? [ ] [ ] 11. Do you have trouble breathing or do you cough during or after exercises? [ ] [ ] 12. Do you have any sprained, dislocated, fractured, or broken bones or joints? [ ] [ ] Explain all “yes” answers and list any ailments or conditions not listed_______________________________________ ______________________________________________________________________________________________ List all medications:_______________________________________________________________________________

Assumption of Risk Agreement and Waiver I, the undersigned participant, assume all responsibility for any and all risks of damage or bodily injury that may occur to the undersigned while attending or participating in the Annual Dai-Ichi Shotokan Karate-Do Training Camp to be held in Panama City, Panama. The undersigned hereby releases and discharges the Dai-Ichi Shotokan Karate-Do Association, and all its officers, instructors, volunteers, members, camp directors, facility owners, their respective officers and agents, successors, and anyone else involved in the conduct of this Training Camp from all claims, demands, rights of cause, or action resulting, from or arising out of incident to the undersigned while participating in said Training Camp. Signature: ___________________________________________ Date: _________________________

Participant Signature: ___________________________________________ Date: __________________________ (Parent or Guardian if under 18 years)

Camp Panama 2013 - Hosted by DSKA (Karate Event)

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