Camp HIS KIDS Unplugged Sign-Up

NOTE: You must complete a separate application for each child who wants to participate.

Has this child attended Camp HIS KIDS in the past?
Treatment Status
T-shirt Size

I hereby give permission for the child named above to participate in the HIS KIDS Camp Unplugged program and all events/activities connected with said program. 

Your Signature

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Ph: (618) 654-4020- St. Louis

  (941) 302-8412-Florida

Fax: (618) 654 4499

PO Box 412, Highland, IL 62249, USA