T1D Camp Grant Application
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Camper Information
Name of Camper
First Name
Middle Initial
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Parent's Name
First Name
Last Name
Parent's Email
example@example.com
Parent's Mobile Phone Number
How long have you been a member of our T1DMS FB Group? (minimum one year)
Minimum one year
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T1D Camp Information
Name of T1D Camp your child would like to attend
*
Name of Camp Director /
*
Camp Telephone Number
Camp Email
example@example.com
Camp Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Please answer the following questions:
In a few words, please explain why you decided to apply for the T1D Camp Tuition Grant and how do you plan on paying the rest of the camp fees.
*
In a few words, please describe why your child wants to go to camp and how this experience would benefit him/her. If your child is older than 8 yrs of age, please have your child answer.
*
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Submission of Application
Signature of applicant or guardian representative
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Submit
Should be Empty: