Please complete the following form with information on the prospective camper. A Handi*Camp staff member will contact you soon to answer any questions you may have and to send you additional information.

Prospective Camper NAME

First Name

Last Name

Parent/Guardian/Contact Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Prospective Camper's Age

Prospective Camper's Disability/Diagnoses

Prospective Camper's Intellectual Disability Level

Prospective Camper's School/Grade Level

If prospective camper is in school, please provide GRADE LEVEL and/or DESCRIBE TYPE of SPECIAL EDUCATION PROGRAM, if applicable.

Additional Comments or Message

Handi*Vangelism Ministries International

Handi*Vangelism Ministries International

Camper Interest Form

Handi*Vangelism Ministries International

Camper Interest Form

Handi*Vangelism Ministries International

MAILING ADDRESS: PO Box 122, Akron PA 17501-0122

physical Headquarters: 3261 ROTHSVILLE ROAD, AKROn pa 17501

CONTACT US | PHONE: 717.859.4777

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