2020 Mission Evansville Group Leader Registration (due March 2)
This form is to register a new group. Individual registrations will be submitted separately.

1 adult participant is required for every 3 youth.

Payments can be made as follows:
Initial Deposit - $60 per person (non-refundable) due with parish group registration by Monday, March 2.
Balance and Individual Registrations are due Friday, April 20.
Please make your check out to "Diocese of Evansville", memo Mission Evansville. Your check must be received at the address below within 14 days of your group registration or we will release your spaces.

Cindy Shoulders
Mission Evansville
5779 Epworth Road
Newburgh, IN 47630

Registration Questions - contact Cindy Shoulders
phone: 812-453-6130
e-mail: cshoulders11@gmail.com

Please attend our Group Leader meeting on Tuesday, March 10, 6:30 PM to receive the Pre-Trip Planning Packet.


Contact Leader First Name *
Your answer
Contact Leader Last Name *
Your answer
Church *
Your answer
Email *
Your answer
Mailing Address *
Your answer
City, State, Zip Code *
Your answer
Primary Phone Number *
Your answer
Secondary contact leader and email address
Your answer
Has your church attended a work camp before? *
If yes, what was the name of the camp?
Your answer
How many YOUTH (under 18) spots do you want to reserve? *
Your answer
How many ADULT spots do you want to reserve? *
Remember, we require 1 adult chaperone for every 3 youth. Adult chaperones need to be 25+ years old and successfully completed Safe Protection training and background check. Young adults ages 18-24 are welcome but do not count as chaperones.
Your answer
Are you available to come to the Group Leader meeting on Tuesday, March 10 at 6:30 PM to receive the Pre-Trip Planning Packets for your participants? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy