Financial Scholarship Request Form

Financial Scholarship Request Form
We do our best to make sure all kids have a chance to come to camp and grow in Christ but ask applicants to seek avenues for assistance first (i.e. church, etc...).
Applicant's Details

(Name of camper money will be used towards)
Name*

First NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Date
Grade in Fall*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Parent/Guardian Name*

First NameLast Name
Relationship to Student*
Have you asked for assistance from your Church or another organization?*

YesNo
Name of Church or Other Organization and City
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church or Other Organization amount given:
Enter dollar amount church or other organization is helping with if the above church or other organization is giving assistance as well.
Have you asked for assistance from Rock River Christian Camp in previous years?*

YesNo
Is this your first year attending Rock River Christian Camp?*

YesNo
Other Household Dependents
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Please explain your reason for your financial assistance request (i.e. lost job, single parent, etc.)*
Amount requesting for Assistance:*
Camp Session Attending:

Teddy Bear CampEmbark Camp (4th-6th)ELEVATE Camp (6th-8th)EDGE Camp (9th-12th)Boys' Paintball CampEquestrian CampOther
Rock River Christian Camp and the CCCA have permission to use any pictures/videos of my camper in publicity materials.
Parent/Guardian Signature (if under 18)*

Clear
Date*

MonthDayYear
Date
Someone from the office of Rock River Christian Camp will contact you once your application has been received and reviewed to let you know the amount that will be given to you towards your camp session(s). If you have further questions, you may contact the camp office at 815-493-6622 or email at rrccoffice@gmail.com.
Should be Empty:

Financial Scholarship Request Form

Applicant's Details

Other Household Dependents