Camp Scholarship Application
The Copigaue Community Cares Coalition is sending 10 children/teens ages 5 - 13 to summer camp through a partnership with KiDS NEED MoRE. Camp is held at the Saddle Rock Ranch in Middle Island, Transportation provided. Dates Monday 7/8 - Friday 7/12/2024
In addition Teens ages 14 - 16
May also be eligible for Leadership-in-training & Counselors-in-training opportunities
Please complete one application per child.
If you have multiple children in the home you’ll need to complete one full application per child
How many applications will you be submitting?
Child’s Name
First Name
Last Name
Parent/Caregiver’s Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Child’s Birthday
-
Month
-
Day
Year
Date
Child’s Age
The Camp scholarship is open for children ages 6 - 14
Race/Ethnicity
Please share how you would describe your race/ethnicity
Preferred Language
What is the preferred language you speak at home
Family
Who lives in the household with the child. Please provide relationships and ages
Has your child experienced an interruption of the normal childhood experience?
Bereaved/Loss of a family member
Homelessness
Foster Care
House Fire
Serious injury/ Accident in the family
Serious illness in the family
No interruption
Other
Please provide any details you are comfortable with sharing about the childhood interruption.
Please provide any information regarding your child's special achievements and talents that you would like to share.
How did you hear about this application?
Upload a photo of your child *optional
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please attest that you are the primary caregiver of this child.
*
Yes, I am a primary caregiver
Signature
Submit
Should be Empty: