Levitate Camps Financial Assistance Application

Levitate Camps Financial Assistance Application
PRIMARY CONTACT (PARENT/GUARDIAN INFORMATION):
Campers Name*
Your Name*
Relationship to Camper*
Address*
Primary Phone Number*
Format: (000) 000-0000.
Email Address*
example@example.com
Who is responsible for Payment?*
Full Name
Signature*
Please describe the reason you are requesting financial assistance*
Familys Gross Income for most recent calendar year
Optional - If you chose to omit this information, please explain why in the response to the question above.
How many family members receive total support from this income
Optional - If you chose to omit this information, please explain why in the response to the question above.
(Optional) Please attach or provide a copy of the first page only of your most recent federal income tax return or W-2. If you do not have this information, please provide letters detailing social security benefits, unemployment compensation, child support, or other income. If your income is not reflected in these documents, please explain how your income has changed or provide information on your extenuating circumstances.
IMPORTANT: Please Black out your social security number and other protected information before submitting
File Upload

Cancelof
FAMILY CONTRIBUTION & FINANCIAL ASSISTANCE REQUEST:
We want to aid as many campers as possible, for this reason we ask families to contribute as much as they can reasonably afford. This contribution demonstrates both a desire and commitment to participate. We are also accomodating and understanding of difficulties you may be facing so please free to reach out to Pat@Levitatefoundation.org if you are unable to meet this requirement.
Of the total camp tuition amount:*
Please Type Total Tuition Amount of desired session(s)
Our Family Can Contribute:*
Please Type Total Amount Your Family Can Contribute
CONTACT INFORMATION FOR VOLUNTEERING:

(If interested!)
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Should be Empty:

Levitate Camps Financial Assistance Application

PRIMARY CONTACT (PARENT/GUARDIAN INFORMATION):

FAMILY CONTRIBUTION & FINANCIAL ASSISTANCE REQUEST:

CONTACT INFORMATION FOR VOLUNTEERING: