2017 Dodd City “Camp of Champs!”

June 5 – 7

9am – 12pm

Dodd City New Gym

 

Grades 3^rd – 9^th:  Boys & Girls

The grade you are entering.

 

Camp Price:

Before June 1^st : $60.00

After June 1^st :   $65.00

**ALL PARTICIPANTS WILL RECEIVE A T-SHIRT**

 

Please detach and mail this form with payment to:

Dodd City High School

Coach Stephenson

602 N. Main

Dodd City, Tx. 75438

*Make checks payable to Alex Stephenson*

 

Name:__________________________

 

Age: _____

 

Grade Entering: ________

 

Address: ______________________________

 

Phone: _________________

 

Shirt Size: ____________

I hereby release any and all personnel and organizations associated with the camp of any liabilities concerning injury that might occur in camp related activities.  Should my child sustain an injury, I should be contacted by phone as soon as possible.

 

Parent/Guardian Signature: _______________________

 

Date: _________

 

Phone: ______________________

 

Doctor’s Name: __________________________

 

 Phone: _________________

 

Emergency Contact: _______________________

Phone: _________________