Re-Creation Kids Camp
Use the form below to register for the July 26-27 RE-CREATION KIDS CAMP at The Vision.

Camper's First Name (required):

Camper's Last Name (required):

Camper's Birth date:

Camper's Age (required):

Camper's Gender (required):

Camper's T-Shirt Size(required):

Please list any medical conditions or allergies we should be aware of

Camper's Mailing Address (required):

City (required):

State (required):

Zip Code (required):

Parent/Guardian's First Name (required):

Parent/Guardian's Last Name (required):

Parent/Guardian's Home Phone (required):

Parent/Guardian's Cell Phone:

Parent/Guardian's Work Phone:

Parent/Guardian's Email (required):

Transportation: How will camper travel to/from camp?

Other than yourself, please list the names and phone numbers of up to three people with permission to pickup your child:
Emergency Contact/Child Pickup 1:
First Name:
Last Name:
Phone Number:

Emergency Contact/Child Pickup 2:
First Name:
Last Name:
Phone Number:

Emergency Contact/Child Pickup 3:
First Name:
Last Name:
Phone Number:

If Coming with a Group: Church/Organization Name:

How did you hear about us?:

If OTHER, please specify:

The $15 registration fee can be paid by check to Vision Ministry, PO Box 189, Laceys Spring, AL 35754 or online by PayPal by clicking the link below. Please include RE-CREATION CAMP and the name of your child in the memo line of your check or PayPal Payment.