2025 Summer Camp
Scholarship Application Form
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Current Grade Level
*
Gender
*
Male/ Female
Current School Name
*
Parent / Guardian Information
Parent 1
Parent Name
*
First Name
Last Name
Home Phone
*
Email
*
example@example.com
Work Phone
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Home Phone
Email
example@example.com
Work Phone
Address
Street Address
Street Address Line 2
City
State / 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.
Camp Contact Name
*
Camp Start Date
*
Type of Camp (Sports, STEM, Arts, Outdoor, Day Camp, etc
*
Camp TShirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Camp Cost
*
Additional Information
Monthly Family Income (Gross)
*
$
Additional Income
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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Camper
*
Alternative Phone Number
*
Please enter a valid phone number.
Medical Information
Does the Camper have any Medical conditions or Allergies
*
Yes
NO
If yes, Please List and explain
Is the Camper Currently Taking Medication
*
Yes
No
If Yes, Please Explain
Primary Care Physician Name and Contact Number
*
Parent/ Guardian Signature
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submission Instructions
Click Submit and email camp flyer or camp website info to info@windsofdestiny.org. Include your name and phone number
Continue
Continue
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