Sddc 2008 Application Form 20080606

Slam Dunk for DC Goals that Matter for Life

Calvin Coolidge High School 6315 5th St., Northwest Washington, DC 20011 Sponsored by the Calvin Coolidge Alumni Association

APPLICATION/PERMISSION FORM Please provide all the information requested and return this part to Calvin Coolidge Senior High School at the address above. Campers must be 9 through 14 years old to attend. Student First Name

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Student Last Name

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Parent/Guardian First Name

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Parent/Guardian Last Name

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Day Phone Number

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Cell Phone Number

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Emergency Contact Person

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Emergency Phone Number

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Student’s School

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Student’s Grade Next Year

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Home Address

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Student’s Birth Date

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Very Important: Please describe any medical condition(s) relevant to the student that might affect his/her ability to participate in a basketball camp that involves strenuous physical activity. Also, please indicate any medications that the student must take during the day:

As the Parent/Guardian of __________________________, I give my permission for him/her to attend The Slam Dunk for DC Camp 2008, if selected. I understand that the Slam Dunk for DC Camp does not provide transportation to or from the Camp. I will ensure that this student arrives on time and, if transportation is by automobile, it will be available promptly at Camp closing. Should this student require medical treatment while participating in the Slam Dunk for DC Camp, I hereby authorize the Camp Staff to obtain appropriate medical services. Furthermore, if the Camp's Staff are unable to reach the parent or guardian designated above, I give my consent to the the Camp Staff to take my child to a hospital, emergency care center, or available physician.

Parent/Guardian’s Signature: ____________________________________________________________

Slam Dunk for DC camp sessions are operated at Washington DC public school under a fee-waiver agreement granted by the Washington DC Public School System (DCPS). The 2008 sessions are made possible by the Calvin Coolidge Alumni Association with funding from individual and organizational friends of Slam Dunk.