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Basketball Wellness Days

Questions marked with a * are required

Registration

This event is open to all Tribal youth ages 10-18 from Humboldt County.

Please fill out the whole form. You will receive a confirmation email once it is complete.

If you do not receive the email, please reach out to Vincent Feliz at vincentf@ncidc.org, or Karen Asbury at karen@ncidc.org, or call the program 707-445-8451 to confirm that we have received your registration.

Thank you for your interest in the event!

All information provided on the form will be kept confidential and will not be shared with any external parties.

Attendee's Contact Information (Other family members asked for later)

First Name

Last Name

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Email Address

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Address Line 2

City

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