Thank you for your interest in Camp Independence! At this point, all camper spots are full. However, if a spot opens up, we'd love to be able to get in touch with you. Please fill out this form and you will be contacted if a space matching your child's age and gender becomes available. Thank you!

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* 1. Camper First Name

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* 2. Camper Last Name

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* 3. Parent(s) First Name

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* 4. Parent(s) Last Name

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* 5. Email Address

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* 6. Phone Number

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* 7. Camper's Gender

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* 8. Camper's age at the time of camp (July 14-19)

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* 9. Camper's Medical Status (ex. Kidney Transplant, Liver Transplant, dialysis,CKD, etc.)

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* 10. Has your child attended Camp Independence before?

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* 11. Any other comments?

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