Kid's Camp Registration 2025

Name

Registration (Pick only one)

Overnight camper Day Camper - not staying overnight

Date of Birth

Gender

Demographic Info (used for statistic purposes only)

Roommate Preference

Grade finishing

Graduation Year

T-Shirt size

Does your child have any dietary restrictions?

If Yes, please explain

County

Parent/Guardian Informatioin

Parent/Guardian

Parent/Guardian 2

Address

This address will receive a confirmation email

Best contact phone

Additional Information

If Other, please list church name

How did you hear about Kids Camp?

Children's Pastor or Church Contact Name

Children's Pastor or Church Phone

Children's Pastor or Church Email

Authorized Adults to Pick Up my Child

If you do not plan on picking your child up from camp or if they are not riding home with their children's pastor / leaders, please list the adults who have your permission to pick up your child(ren).

They will be asked to show photo ID at the camp office upon arrival. We WILL NOT release your child(ren) to anyone who is not listed or does not have photo ID - no exceptions.

Please list all names and phone numbers in the space provided below.

Please list names and phone numbers of all adults who have parent/guardian permission to pick your child(ren) up from camp.

Media Release

We will be taking photos and videos throughout the week at camp to post on Facebook and Instagram for families to be able to view during the week and after the camp has ended.

I authorize Fairmount Camp to photograph or post videos of my child on social media.

Please make sure to follow the Medical Release Form link in your confirmation email and submit that form. WE MUST HAVE THIS FORM FOR YOUR CHILD TO STAY AT CAMP. If you choose to not fill it out online, please feel free to print it off and mail it into us at:
Fairmount Camp
711 E 900 S
Fairmount, IN. 46928

Grant Assessment Information

In order to receive grant funding for future programming, we need access to some valuable information for the kids that attend our camps. If you would be willing, please fill out the following information regarding your household. None of these questions are required and ALL information will be kept confidential and will not be sent to any other camps or agencies.

What school corporation does your child attend?

Does anyone in your household have a physical or mental disability? Yes No

Does anyone in your household under the age of 18 have a physical or mental disability? Yes No

Does your household qualify for free or reduced lunches at school? Yes No

Does your household consist of the following? Single Parent 2 Parents Grandparents living in the home Other relative or non relative living in the home helping with child care

How many people currently live in the home?

How many people 18 and younger live in the home?

Have you ever been a foster parent? Yes No

What is your annual household income? Less than $25,000 Between than $25,000 - $50,000 Between $50,000 - $75,000 Between $75,000 - $100,000 Over $100,000

Payment Options

Registration needs to be paid in full on or before June 30, 2025.

You may choose to make partial payments via check or online.

If you are paying online, there is a 4% processing fee. This is the minimum fee that we are charged to process your transaction.

If mailing a check, please write "Kids Camp" and your child's name in the memo section and send to:

Fairmount Camp
711 E 900 S
Fairmount, IN 46928

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Kid's Camp Registration 2025

Description

Please Fix the Following