Campership Application Form

Campership Application Form

Berkshire Museum Camps at Berkshire Community College 2025
Camper's Information

Personal & Health & Contact
Name *

First NameLast Name
Birth Date*

MonthDayYear
Age (at time of camp)*
Grade (entering this fall)*
List Any Allergies and Dietary Restrictions
Medications & Frequency
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence will be sent to this person)
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Relationship with the Camper*
Emergency Contacts and Authorized Pick Up Persons*
Emergency Contacts and Authorized Pick Up Persons*
Camp Options

Please select the camp/s you'd like to request assistance for.
Select Camp

June 30-July 3 Dino Discovery PreK-KJuly 7-July 11 Nature Enthusiasts Grade 1-2July 14-July 18 Colorful Creations Grade 1-2July 21-July 25 Showbiz Camp Grade 3-6July 28-August 1 Historians of the World Grade 1-2August 4-August 8 Art & Monsters: CryptozoologyAugust 11-August 15, Manga Camp, Grade 6-8August 18-August 22, Gameboard Play and Design, Grade 4-8August 25-August 27, Colorful Creations Jr., PreK-K
Employment Information

Please ensure all information is accurate and up to date.
Name of Employer*
Employer's Phone Number*
Employer's Address*
Employer's Email
Spouse's Name*
Name of Spouse's Employer*
Spouse's Employer's Phone Number
Spouse's Employer's Address
Spouse's Employer's Email
Monthly Household Income

Please enter amount received each month next to each income type
Wages*
SSI Income*
AFDC Income*
Unemployment*
Disability*
Child Support*
Other (please specify)*
TOTAL MONTHLY HOUSEHOLD INCOME*
Please upload documentation from all income you are receiving. All household members who are working are asked to provide pay stubs from the previous three pay periods. *

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Household Residents

Please answer the questions below about the other residents in the household.
How many dependent children are currently living in the household*
Have you received financial assistance from the museum in the past?*

YESNO
If yes, when?
What type of assistance did you receive from the museum? (list program)
What is the total dollar value of the assistance received from the museum in the past?
Enter dollar amount
Terms & Conditions

The Berkshire Museum makes every effort to address the needs of families and/or individuals applying for assistance. Applying for financial assistance does not automatically guarantee that assistance will be granted, as the assistance will be based on the documented financial need and availability of resources of the Museum. The Museum reserves the right to deny or discontinue financial assistance at any time. After completing your application form and attaching proper documentation, your request will be reviewed and, if necessary, you will be contacted by telephone with any questions we may have. A determination on your request will be made as soon as possible. You will be notified by phone as to the assistance granted. If you need to contact someone regarding your application, please write to Betty Connally at bconnally@berkshiremuseum.org.
Date

MonthDayYear
Date
The statements I have given are true and correct. Signature

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Campership Application Form

Camper's Information

Parent / Guardian Information

Camp Options

Employment Information

Monthly Household Income

Household Residents

Terms & Conditions