Camp Kooky Scholarship application

Anne's Fund Scholarship Application

Camp Kooky
Which week(s) are you planning ot attend? *

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
*NOTE: You MUST pay a deposit in order to be considered
Total cost of attendance *
Amount deposit paid *
Camper's age
Parent Name
Phone #
Email address
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Siblings not attending
Siblngs not attending
Siblings not attending
Sibings not attending
Siblings not attending
Have you attended Camp Kooky before?

Yes NO
If yes, when?
Have you attended other Island Community Center programs?

Yes NO
If yes, what programs?
Have you received scholarhsip funds to attend Camp Kooky before?

Yes No
What is your monthly or yearly income before taxes? Include both parents.
Parent/Guardian Signature *

Clear
date

Month Day Year
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform