Camper Name
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Parent Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
*
Position
*
Household Total Monthly Income
*
Number of people in home
*
Number of children under 18 in home
*
Please explain specific reasons for scholarship request
*
Number of Campers Attending
*
Amount you are able to contribute toward Registration Fee
*
Amount of Scholarship you are requesting
*
Submit
Should be Empty: