DCC Summer Basketball Camp 2023

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June 12-15, 2023

ZIP Code *

Email address *

Cell Phone Number *

City *

Address 1 *

Last name *

State *

First name *

Parents Name: *

Emergency Contact? *

Relationship?

School?

Grade Fall 2023?

Age? *

Height?

T Shirt Size? *

YS YM YL AS AM AL AXL AXXL

Camp Session *

Age: 4-6 (12:00PM-1:00PM) Age: 7-11 (8:30AM-11:30AM) Age: 12-17 (1:30PM-4:30PM)

Insurance Plan *

Policy Holder's Name? Policy/Group No.

Is camper allergic to any medication? *

If yes, what?

Any medication being sent with camper? *

Print Name *

Please sign Parental Consent and Medical Waiver Form on registration facility site, or download camp registration form.

4-6 years old $50
7-11 years old $85
12-17 years old $85
on-site Registration add $15

Contact Information:

Joseph Peterson
jpeterson@dawson.edu
406-377-9459

* required field