Camper Application
Please fill out this form then click on submit. Any questions, contact us. Thank you.
Email address *
Name (First and last) *
Photo Headshot *
Required
School *
Birthdate *
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Gender *
Age *
Height (Feet) *
Weight (lbs) *
Street Address *
City *
State *
Zip *
Main Phone *
Cell Phone *
Pick one T- Shirt and short size *
T- Shirt Youth Size
T- Shirt Adult Size
Short Youth Size
Short Adult Size
Shoe Size *
Camper Session *
Health Insurance Carrier *
Address of Carrier *
Name of Policy Holder *
Policy # *
Effective Date *
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Expiration Date *
MM
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DD
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Do you have food allergies? *
Are you allergic to any medicine? *
Are you allergic to any medicine? *
Do you take medicine regularly? *
Do you have or had any medical problem? *
Doctor's Name
Emergency Contact Name *
Emergency Contact Number *
Emergency Contact Number *
Do you need AZDF Transportation from Tucson International Airport to the camp? *
One sentence why do you love basketball?
How did you hear about the camp? *
AGREEMENT - The parent or legal guardian should sign this consent form so that appropriate diagnosis and treatment may be promptly carried out and so that no unnecessary delays will occur with emergency health service procedures. No major health service will be performed except in an emergency, without parents or legal guardians being contacted and fully informed. It should also be understood that under certain circumstances the camper would be transported to area hospitals for treatment and/or diagnosis. I give permission for such diagnosis, therapeutic, voluntary immunization, operative procedures, and transportation as may be deemed necessary for may son/daughter who is under the age of eighteen. I hereby give permission for the use of my child’s photo and video to be used on the Arizona School for the Deaf and Blind, Southwest Deaf Optimist Club, Arizona Desert Fire and other camp publications. By my signature, I also understand that any camper who does not abide by the rules and regulations promulgated by the ASDB and/or SDOC is subject to dismissal without reimbursement. *
Required
Signature of Parent or Guardian *
Date *
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Comments
Payments *
Submit
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