Galena Exploration Camp Scholarship Application
Camper's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
School your Camper attends
*
Is your Camper in Foster Care?
*
Yes
No
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Family Information
Guardian Info
Guardian Name
*
First Name
Last Name
Home Phone
*
-
Area Code
Phone Number
Work Phone
*
-
Area Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Guardian 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
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Additional Information
Camper's Gender
Male
Female
Please Explain the Reasons for Need
*
Does your Camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
*
Does your Camper need medication while at Camp? List all medications below including Epi Pen or Inhaler and clear instructions.
*
Exploration Camp your child wishes to attend.
*
Please Select
Spring Exploration Camp
Summer Exploration Camp
Winter Exploration Camp
If you selected Summer Exploration Camp, please choose 3 below camp weeks that would work for you. Please check out WWW.Galenacreekvisitorcenter.org for information on specific camp weeks and field trips.
Animal Adventures June 10th-14th DAY ONLY
Bug's Life June 17th-21st DAY ONLY
Forest Defenders June 24th-28th DAY ONLY
Wilderness Adventure 1 July 1st-5th DAY ONLY
Wilderness Adventure 2 July 15th-19th OVERNIGHT
Water Exploration July 22nd-26th OVERNIGHT
Rockin Out July 29th-August 2nd OVERNIGHT
Wild Wild West August 5th-9th OVERNIGHT
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