Summer Camp Scholarship Application Form
Parent/Guardian Information
Name
*
First Name
Last Name
Cell Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Applicant:
Mother, Father, Grandmother, etc.
Annual Family Income (Gross)
*
$
Total Monthly Income
Please Explain the Reasons for Need
*
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Camper Information
Please provide the following information on behalf of the child you are applying for.
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Child's Gender
*
Male
Female
Grade for upcoming school year:
*
Which camp would you like to apply for?
*
Please Select
Farm Camp Jr. - June 11th-14th (3rd – 5th grade)
Farm Camp - June 18th - 21st (6th grade – 15 y/0)
Farm Adventures Camp - June 26th-27th (Kindergarten – 2nd grade)
Little Farmers Class - July 2nd (ages 3-5)
Arts and Animals Class - July 9th (ages 6-8)
Farm Camp Jr. - July 16th-19th (3rd – 5th grade)
Farm Camp - July 23rd-26th (6th grade – 15 y/0)
Farm Adventures Camp - July 30th-31st (Kindergarten – 2nd grade)
Will your camper be taking any medications while at camp?
*
Yes
No
Please select the type of camp you'd like to register for:
Little Farmers (Ages 3-5 with an adult)
Arts & Animals (Ages 6-8)
Farm Adventures (Kinder - 2nd Grade)
Farm Camp Junior (3rd - 5th Grade)
Farm Camp (Ages 12-15)
Select a Little Farmers Session:
Please Select
June 2, 9, 16 – Little Farmers
June 30, July 7, 14 – Little Farmers
Select a Farm Adventures Session:
Please Select
June 11-12 – Farm Adventures
June 25-26 – Farm Adventures
July 1-2 – Farm Adventures
July 29-30 – Farm Adventures
Select Arts & Animals Session:
Please Select
June 24 – Arts & Animals
July 17 – Arts & Animals
Select a Farm Camp Junior Session:
Please Select
June 3-6 – Farm Camp Junior
June 17-20 – Farm Camp Junior
July 8-11 – Farm Camp Junior
July 22-25 – Farm Camp Junior
Select a Farm Camp Session:
Please Select
June 10-13 – Farm Camp
July 15-18 – Farm Camp
Please list any medical restrictions, dietary restrictions, or allergies:
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Terms, Conditions, and Policies
How did you hear about Summer Camps at Timberview Farmstead?
Please Select
Word of mouth
Email
Facebook
Instagram
EventBrite
School
Broadcast News/radio
Other
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