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)
Please list any medical restrictions, dietary restrictions, or allergies:
Will your camper be taking any medications while at camp?
*
Yes
No
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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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