Voyager Summer Camp Scholarship Application Form
Child's Full Name
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
Date
Child's Age
Which Program are you interestd in?
Adventure Wednesdays
Hike and camp Mount Hayden
Rafting with Deer Hill
Retreat with Moxie Outdoors
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Family Information
Parent 1
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other children in family
Configurable list
*
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Additional Information
Monthly Family Income (Gross)
$
Total Monthly Income
Scholarship Amount Requested
25%
50%
100%
Other
Additional Comments:
Submit
Should be Empty: