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 ________________________ Student Last Name ________________________

Parent/Guardian Parent/Guardian
First Name ________________________ Last Name ________________________

Day Phone Number ________________________ Cell Phone Number ________________________

Emergency Contact ________________________ Emergency Phone ________________________

Person Number

Student’s School ________________________ Student’s Grade ________________________

Next Year

Home Address ___________________________________________________________________________

___________________________________________________________________________

Student’s Birth Date ________________________

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.