Choctaw Nation of Oklahoma

BASKETBALL CAMPIDABEL HIGH SCHOOL or

BROKEN BOW SPORTS COMPLEX

July 7 - 8 • 9:00 am - 3:00 pm

CARL ALBERT STATE COLLEGE or

HEAVENER HIGH SCHOOL

July 10 - 11 • 9:00 am - 3:00 pm

RATTAN HIGH SCHOOL or

TALIHINA HIGH SCHOOL

July 14 - 15 • 9:00 am - 3:00 pm

TUSHKA HIGH SCHOOL or

COALGATE HIGH SCHOOL

July 17 - 18 • 9:00 am - 3:00 pm

McALESTER HIGH SCHOOL or

WILBURTON HIGH SCHOOL

July 21 - 22 • 9:00 am - 3:00 pm

SOPER HIGH SCHOOL or

SOSU GYM in DURANT

July 24 - 25 • 9:00 am - 3:00 pm

DEADLINE FOR APPLICATION IS APRIL 18, 2014

NO BUSSING SCHEDULE

FOR BASKETBALL

Name: Phone:

Address: City: State: Zip:

Age: Date of Birth: Male / Female

Circle T-Shirt Size: Youth (10 - 12) (14 - 16) ; Adult (Small) (Medium) (Large) (X-Large) (2X-Large) (3X-Large)

Have you attended any of our camps? Y N List the camp & how many years:

Do you have insurance? Y N List insurance information:

Emergency contact person & phone #:

Medical Information:

CONSENT: I authorize a representative of the Choctaw Nation Staff, Camp Director, and Instructor to seek medical treatment for my child, if I am not present, while participating in this camp. In consideration of the sponsors and facility owner accepting this application, I hereby release and waiver all rights to any claim for damages and/or injury my child may suffer while participating in this camp. I understand and agree that medical or other services rendered to my child by the camp sponsors/facility owner is not an admission of liability or continued services.

Signature of Parent / Guardian Date

CAMP LISTINGSelect the camp you will be attending. Ages 8 - 18. Deadline: April 18, 2014

Registration: 8:00 am - 9:00 am

NO BUSSING SCHEDULE

JULY 7 - 8 • 9:00 AM - 3:00 PM

Idabel High SchoolBroken Bow Sports Complex

JULY 10 - 11 • 9:00 AM - 3:00 PM

Carl Albert State CollegeHeavener High School

JULY 14 - 15 • 9:00 AM - 3:00 PM

Rattan High SchoolTalihina High School

JULY 17 - 18 • 9:00 AM - 3:00 PM

Tushka High SchoolCoalgate High School

JULY 21 - 22 • 9:00 AM - 3:00 PM

McAlester High SchoolWilburton High School

JULY 24 - 25 • 9:00 AM - 3:00 PM

Soper High SchoolSOSU Gym in Durant

CAMPER MUST WEAR APPROPRIATE SHOESNO FLIP-FLOPS OR SANDALS

CAMPER WILL NOT BE ALLOWED TO PLAY BAREFOOT THIS YEAR

Office Info

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ATTACH COPY OF CHOCTAW MEMBERSHIP AND CDIB

ALL CAMPERS MUST PARTICIPATE! PLEASE NOTIFY CAMP STAFF IF CHILD WILL BE PICKED UP EARLY.

Choctaw Nation of Oklahoma

BASKETBALL CAMPDeadline: April 18, 2014

INSTRUCTIONS:Complete Application and Sign.

Mail to: Choctaw Summer Camp • c/o Kevin Gwin • PO Box 1210 • Durant, OK 747011-800-522-6170 • Fax: 580-920-3129

Choctaw Nation of OklahomaAttention: Cultural Events-Summer CampsP.O. Box 1210Durant, Oklahoma 74702

PLACE

STAMP

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