Parent/ Guardian Name
First Name
Last Name
How Many Campers?
Camper Name
First Name
Last Name
Camper Name
First Name
Last Name
Camper Name
First Name
Last Name
Camper Name
First Name
Last Name
Camper Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Questions and Details:
Why are you requesting a scholarship?
Have you contacted your church about help paying for camp?
Yes
No
How much are you requesting as a scholarship? (Per child)
$25
$50
$100
Other
Type a question
Submit
Should be Empty: