2025 Summer Camp

2025 Summer Camp

2025 Summer Camp

Scholarship Application Form
Child's Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current Grade Level*
Gender*
Male/ Female
Current School Name*
Parent / Guardian Information
Parent 1
Parent Name*

First NameLast Name
Home Phone*
Format: (000) 000-0000.
Email*
example@example.com
Work Phone
Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2
Parent Name

First NameLast Name
Home Phone
Format: (000) 000-0000.
Email
example@example.com
Work Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other children in family
Additional Children
Summer Camp Information
Camp Name*
Camp Location*
Camp Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Camp Contact Name*
Camp Start Date*
Type of Camp (Sports, STEM, Arts, Outdoor, Day Camp, etc*
Camp TShirt Size*
Camp Cost*
Additional Information
Monthly Family Income (Gross)*
$

Additional Income

Rows	Income ($)
Welfare AFDC
Child Support
Support from Spouse
Income from 2nd Job
Other
Total Additional Income

Total Monthly Income*
Please Explain the Reasons for Need*
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Camper*
Alternative Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
YesNO
If yes, Please List and explain
YesNo
If Yes, Please Explain
Primary Care Physician Name and Contact Number*
Parent/ Guardian Signature
Signature*

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Date Signed*

MonthDayYear
Date
Submission Instructions

Click Submit and email camp flyer or camp website info to info@windsofdestiny.org. Include your name and phone number
Should be Empty: