Kids Camp Parents 2024

Please complete this online registration for each camper separately. Please note: Registration is not complete until payment is received. Payment can be mailed by check to address below (ONE CHURCH CHECK PER GROUP). * If church is mailing check, please mark "PAY LATER"

Co-director BRIENNA STAMPER, 1902 Main St, Vincennes, IN 47591

Camper check-in/ check-out

Arrival Sunday June 30, 4:30 @ East Dorm

Pick up Wednesday July 3, 1 pm @ Barn

Parent Information

- Parent Information needed with easiest way to contact you if needed

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Parent/Guardian Email

* Parent/Guardian Mobile Phone

* Local Church

* Parent/Guardian Address

* Parent/Guardian City

* Parent/Guardian State/Province

* Parent/Guardian Zip/Postal Code

* Name of Emergency Contact

* Emergency Contact Phone #

Medical Information

- Please fill out all medical information completely.

* Medical Insurance

* Medical Insurance Phone

* Insurance Group #

* Insurance Policy #

* Number of kids attending

Parent Information

Medical Information

Processing registration ...