DCC Summer Basketball Camp 2021

There are errors with your form submission. Please review and submit again.

ZIP Code *

Email address *

Cell Phone Number *

City *

Address 1 *

Last name *

State *

First name *

Emergency Contact? *

Relationship?

School?

Grade Fall 2021?

Age? *

T Shirt Size? *

YS YM YL SM MED L XXL

Camp Session *

__4-6 years old__ 7-11 years old__12-17 years old

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.

Send check or money order to:

Dawson CC Basketball
300 College Drive
Glendive, MT 59330

Contact Information:

Romeo Lagmay
rlagmay@dawson.edu
406-377-9450

* required field