WinShape Hartsville Scholarship Application

WinShape Hartsville Scholarship Application
Camper Information
Email
example@example.com
Campers Birthdate

MonthDayYear
Date
Campers Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Which grade is your camper completing this year? (Camp for those completed 5k-5th grade)

5k1st grade2nd grade3rd grade4th grade5th grade
Select Your Household Income
After the $55 registration fee, how much can you contribute?
Scholarships are only awarded after the registration fee is paid. If you are unable to pay the registration fee, please email winshape@kelleytown.org or call 843-332-8092
All scholarship applications must be reviewed by a review committee before any funds can be approved for scholarship use. Scholarships are assigned on a first-come, first-served basis, until all funds have been allocated. SUBMITTAL OF THIS FORM DOES NOT CONSTITUTE A PROMISE OF A SCHOLARSHIP. YOU WILL BE CONTACTED IF A SCHOLARSHIP IS AVAILABLE.

Email winshape@kelleytown.org if you have any questions.
Parent Signature*

Clear
Should be Empty: