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Midwest 2026 Summer Day Camp

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Contact

Address

2115 Garland Ave.,

Louisville, KY 40211

Phone

502-774-3986

Email

e-mail: midwestchurchofchrist@aol.com

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Midwest 2026 Summer Day Camp Interest Survey

Thank you for your interest in the Midwest 2026 Summer Day Camp. Please complete interest survey and then visit us at 2115 Garland Avenue to sign release forms and complete the registration process.

Student's Name*

Personal Information*

Date of Birth

Grade Level 2026/2027 School Year

Male or Female

Total: 0/0

Parent/Guardian Name(s) and Phone Number*

Parent/Guardian Email address*

In order to better serve your child, please indicate if they have been diagnosed with any of the following. Some conditions may require additional information to complete registration.*

None

ADD/ADHD

Autism

Cerebral Palsy

Rett Syndrome

Asthma, Severe Allergies

Convulsions

Asperbergs

Bipolar Disorder

Down Syndrome

Diabetes

Bleeding/Clotting Disorder

Fragile X

Tourettes

Chronic Health Problems

Heart Defect/Disease

Other

List any medications that your child will take while at the Summer Day Camp

Does your child have an IEP or 504 Plan?*

Yes

No