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Indiana UPCI Senior Camp

Early Bird Registration January 1 - June 8

Registration Closes Jun 9

1900 E. Broadway St, Fortville, IN 46040

Registration Options

Senior Camp ($235.00)
Ages 15-18 ($50 Deposit & Make Payments if you want)

Payment Options

Full Payment ($235.00)
Deposit Payment ($50.00)

Camper Name

Date of Birth

Age should be between 14 and 18 as of June 17th, 2024

Gender

Male
Female

Dorm Selection

T-Shirt Size (Optional)

Needed Signatures

You can download a pastor's signature form here.

We need 3 signatures.

1. Your Pastor's signature to approve your child attending camp.

2. The parents signature in case of emergency

3. The student's signature, agreeing to the rules of the camp, which is located on the back of the form.

Signature form upload (Must be completed to register)

Browse

A signed waiver by this registrant will be required before you can download your QR code. A link to obtain waivers for all registrants will be shown on the confirmation page.

Parent/Guardian Name

Mobile Phone Number

Address

Emergency Contact

Emergency Contact Number

Trusted Contacts (Individuals with permission to sign camper in/out from activities. Must be 18+ years old.)

Two licensed nurses will be on staff during the week of camp to administer medications and care for wounds and injuries that may occur. The following information will be useful for the proper care of your child.

Allergies

Medications

Additional medical information that would be helpful for the camp nurses to know about your child (physical limitations, behavioral considerations, etc.)

I hereby grant my permission for the camper named above to receive necessary doctor and medical treatment, which includes over-the-counter medicine, that the camp nurses, or management deems necessary for his/her well-being.

Does the camper get overwhelmed by loud noises and lots of activity? Would he/she benefit from noise canceling headphones or a quiet room to reset?

Give the gift of registration with a voucher for a friend

Amount$

Recipient Email

We will send an email with the voucher code.

Add Voucher

Total

$235.00

Coupon Code

Your current total for 1 Camper is $246.68 (Show Summary)

BILLING INFORMATION

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

June 10-14

Register Today!

CAMPER REGISTRATION

Needed Signatures

PARENT / GUARDIAN INFORMATION

MEDICAL INFORMATION

ORDER INFORMATION

Give the gift of registration with a voucher for a friend

BILLING INFORMATION