Center for Interfaith Cooperation

Hoosiers of Many Faiths in Community

Youth Summer Camp Student Registration Form

Center for Interfaith Cooperation & Watch Club — July 22-26 & July 29- August 2, 2019
Learn how to prepare international-themed snacks

Student information_____________________________________________________

Student(s) name:

Date of birth:


Parent or guardian:

Address (if different than above):



Emergency Contact:

Medications, allergies and/or other important information:         ­­­­­­­­­­­­­­

Youth Camp is scheduled for Monday July 22 through Friday July 26 and July 29 through August 2, 2019. Activities begin at 9:00 am and continue until 4:00 pm, however before and after care will be available from 8-9 am and 4-5 pm for an additional $10.  Students will be dropped off and picked up each day at the Indiana Interchurch Center, 1100 West 42nd St. Payment is due one week prior to the beginning of each camp. A parent/guardian orientation is planned for Thursday July 18 from 4:00-6:00 pm.

Snacks will be provided each day however students must bring their own lunch!

Would you like to register your student(s) for:

____ Week 1 July 22-26 (Full week at $150)

____ Week 2 July 29-August 2 (Full week at $150)

____ $25 discount for additional children

____ Individual day(s) at $40, please indicate which days-

____ Monday   ____Tuesday   ____Wednesday   ____Thursday   ____Friday

____ Before or after (please circle) care for an additional $10.

Please return completed forms to:

Feel free to call Charlie at (317) 318-5304 if there are any questions.  We look forward to working with you and creating a very positive experience for your student at Youth Camp! Feel free to share this information with others who may be interested.