DTC HOOP CAMP 2008 - REGISTRATION FORM

*Please check which camp you are registering for:

Session 1: 9:00am - 12:00pm

__Grades 3-5 Boys (SES)      __Grades 6-8 Girls (SMS)
Session 2: 1:30pm - 4:30pm

__Grades 3-5 Girls (SES)      __Grades 6-8 Boys (SMS)
Session 3: 6:00pm - 8:30pm

__Grades 9-12 Girls (SMS)   __Grades 9-12 Boys (SRHS)
Name of Camper: ____________________________________________________
Parents name/s: ______________________________________________________
Street Address:  ______________________________________________________
Province:  __________________________________________________________
Postal Code: _________________________________________________________
Telephone/S: ________________________________________________________
Email: ______________________________________________________________
Campers Birth date: (M/D/Y)  ___________________________________________
Age at Camp: ________________________________________________________
School Attending in Fall: _______________________________________________
Grade: _____________________________________________________________
In Case of Emergency, Contact: __________________________________________
Contact Number/s: ____________________________________________________
Doctors Name: _______________________________________________________
Social Insurance #: ____________________________________________________
Type of Medical Insurance:  _____________________________________________
T-shirt Size: (circle size):    Youth Med - Youth Large - Adult Small - Adult Med - Adult Large - Adult X-Large
Please list all known medical allergies and/or conditions.
*It is recommended that each camper have a physical examination prior to participating in camp activities.

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                                              WAIVER & RELEASE

I hereby give consent and approval to the participation of the applicant in the Dairy Town Classic Summer Hoop Camp program, and certify that he/she is physically fit to take part in all activities.  Further, I do hereby waive, release and forever discharge said organization, its staff and employees from any and all claims for damages occurring from accident, injury to person or loss of personal property occurring during his/her stay at camp; his/her participation in activities or arising from travel to or from camp.____________________________________________________________

                                           Parent's / Guardian's Signature 

Please make payable to (NO Refunds): Dairy Town Classic Basketball Committee

Return To: Registrar, DTC Summer Hoop Camp, 6 Hillside Crescent, Sussex, NB  E4E 1C1