LSBC Scholarship Request Form

Scholarship Request

LSBC Summer 2025
Parent's Name

First NameLast Name
E-mail Address
Phone Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Camper's Name #1

First NameLast Name
Camper's Name #2

First NameLast Name
Camper #1 Camp attending
Camper #2 Camp attending
Should be Empty: