Camp Scholarship Request Form
Children's Ministry
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your involvement at Ebenezer Bible Fellowship Church?
*
Please Select
Member
Regular Attendee
Visitor
Other
How many children are you requesting a scholarship for?
*
Please Select
1
2
3
4
5
Which camping program is your child(ren) going to?
*
Winter Blast Kids Retreat at Victory Valley ($129)
Victory Valley Summer Day Camp ($289)
Victory Valley Summer Overnight Camp ($424)
Haycock Summer Day Camp ($275)
Haycock Summer Overnight Camp ($475)
Other
What is the scholarship amount you are requesting?
*
Please Select
25%
50%
75%
90%
100%
Please consider if you are able to pay a portion of the cost.
Calculation Field: Total Scholarship $Amt Requested
Calculation Field: Total $Amt you owe the camp:
Total Scholarship $Amt Requested:
Total $Amt you owe the camp:
Please list the child(ren) for whom you are requesting the scholarship:
Name: Child #1
*
First Name
Last Name
Date of Birth (Child #1)
*
-
Month
-
Day
Year
Date
Grade (Child #1)
*
Please Select
K
1
2
3
4
5
Name: Child #2
*
First Name
Last Name
Date of Birth (Child #2)
*
-
Month
-
Day
Year
Date
Grade (Child #2)
*
Please Select
K
1
2
3
4
5
Name: Child #3
*
First Name
Last Name
Date of Birth (Child #3)
*
-
Month
-
Day
Year
Date
Grade (Child #3)
*
Please Select
K
1
2
3
4
5
Name: Child #4
*
First Name
Last Name
Date of Birth (Child #4)
*
-
Month
-
Day
Year
Date
Grade (Child #4)
*
Please Select
K
1
2
3
4
5
Name: Child #5
*
First Name
Last Name
Grade (Child #5)
*
Please Select
K
1
2
3
4
5
Date of Birth (Child #5)
*
-
Month
-
Day
Year
Date
Questions/Comments:
Submit
Should be Empty: