Summer Camp Program Application

Summer Camp Program Application

Personal Data:

Address:
Visual Status:
Membership:
Please State Whether You are Restricted or Unrestricted From Using Stairs:
Are You Allergic to Any Medication?
Physician's Address:

Emergency Contact

Contact's Address:

Agreement Statement

Week Preferred

Select Week Preferred:

Note: Arrival time for week-long sessions is 3:00 pm; Departure time for week-long sessions is 9:00 am. Arrival and departure times for Extended Weekend are after 6:00 pm on Thursday evening and after the noon meal on Sunday. The deadline for submitting applications for the weekly sessions is May 1. The deadline for submitting an application for the Extended Weekend is August 1.

COST

$100.00 for the week-long session – per adult
Non-member (legally blind): $200.00 – per adult
Non-member (sighted): $560.00 – per adult
$75.00 for the extended weekend – per adult
Non-member (legally blind): $150.00 – per adult
Non-member (sighted): $283.82 – per adult
$90.00 per child (under 18)
No charge for children under two.
Checks and money orders must be made payable to: Missouri Council of the Blind. All fields must be completed on application. Please forward this application, along with your check or money order (no cash please) to: Missouri Council of the Blind Summer Camp Program 5453 Chippewa Street St. Louis, MO 63109