Summer Camp Application

Ways to submit this MCB Summer Camp Application:

  1. You may either download this Summer Camp Application, print, complete, and mail to the MCB office at:
    Missouri Council of the Blind
    Summer Camp Program
    5453 Chippewa Street
    St. Louis, MO 63109
  2. You may complete the online application and submit payment securely online via PayPal or credit/debit card.
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MCB Summer Camp Application
Today's Date *
Personal Data
Visual Status *
Select Your Membership *
Are you restricted from using stairs? *
Are you allergic to any medication? *
Emergency Contact Info
Week Preference
Cost and Payment
Week-long session - Adult Camper
Week-long session - Child Camper
Extended Weekend - Adults Only
I have read and agree to the Guidelines for the Summer Camp Program. *
I am attending summer camp at Cobblestone Lodge at my own risk and will not hold the MCB liable for my health/safety while in attendance. *
Submitting this form constitutes your signature. *