2022 Campership Application

2022 Campership Application

Girl Scouts of West Central Florida is committed to ensuring every girl get the opportunity to participate in Girl Scouting.
Please read the complete Campership Guidelines before completing this form. Note that you must have registered for a summer camp session before completing this application. This form does not secure a spot for summer camp registration. Review of applications will begine February, 2022.

Important-Please make sure you review the guidelines and submit required documentation so that your application can be processed. Your application will not be reviewed if you do not submit documentation.

All Information will be kept strictly CONFIDENTIAL.
Camper's Name *

First Name Last Name
Phone Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How does your Camper participate? *

Troop Member Juliette Girl Scout
Troop Number if you belong to one.
Service unit if known
What grade level will your girl scout be entering in the 2022/2023 school year? *

Daisy (K-1) Brownie (2-3) Junior (4-5) Cadette (6-8) Senior (9-10) Ambassador (11-12)
Did your camper participate in the council-sponsoredproduct sales program this year? *

Yes No
If no, Why not
Family Information

This section is for the parent/guardian.
Parent/Guardian Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Address if different than camper

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Number of adult family members living in the home? *
Number of dependent children living in the home *
The following financial information must be completed for each girl applicant.
Select ALL household income sources that apply: *

Salaries / Wages Disability Social Security Food Stamps Child Support Unemployment Other
Indicate total annual gross household income (including assistance) *

$11,000& below $11,001-$15,000 $15,001-$19,000 $19,001-$23,000 $23,001-$26,000 $26,001-$30,000 $30,001-$34,000 $34,001-$38,000 $38,001-$45,000 $45,001-$60,000 $60,001-$75,000 $75,001 & above
Attach your income verification for 2021 to verify financial need (i.e. Tax return, Food stamps, Unemployment, etc.) *

Cancel of
Has your camper received a campership in the past? *

Yes No
If Yes, what year?
You must register for camp session and pay the deposit to be eligible for finical aide. Deposits will be refunded if scholarship amount is declined by family.
Have you registered for a camp session? *

Yes No
What Camp is your camper attending *

Wildwood Horse camp Wildwood Resident camp Wai Lai resident camp Wai Lani STEM day camp Wai Lani day camp Travel Camp
Date first camp starts *

Month Day Year
Date
Amount requested in financial assistance? *
$00.00
Amount you can contribute towards camp fee? *
$00.00
Has your daughter attended Girl Scout camp in the past? *

Yes No
Please explain any special circumstances or reasons that require you to request a campership?
I certify that all information contained in the application are true and complete. I understand that this application will not be considered if I have not registered for summer camp and paid the applicable deposit.
Signature *

Clear
Today's date

Month Day Year
Date
Should be Empty:

2022 Campership Application

Family Information