2019 Don Dziagwa Basketball Camp Registration
This form is a pre-registration. A $50 deposit to secure a spot, or the full payment, is to be mailed to the following address:

Don Dziagwa
c/o Tampa Catholic High School
4630 N. Rome Ave.
Tampa, FL 33603

Please note: Make all checks payable to DON DZIAGWA.
Please check week(s): *
Required
Student's Name *
Your answer
Student's Age *
Your answer
Grade in the fall *
School *
Your answer
Parent's Name *
First, Last (if different)
Your answer
Address *
Street, City, State, Zip
Your answer
Parent Phone/Emergency Contact *
(area code) ___ - ____
Your answer
Parent Email *
Your answer
Parent Consent *
I hereby authorize the Directors of the Don Dziagwa Basketball Camp to act for me according to their best judgment in an emergency requiring medical attention. I hereby waive and release the Don Dziagwa Basketball Camp and Tampa Catholic High School. I know of no mental or physical problems that may affect my child's ability to safely participate in this camp. I will be responsible for any medical or other charges in connection with his/her attendance at camp.
Required
I will be paying by: *
NOTE: Make checks payable to DON DZIAGWA.
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