YMCA Camp Wakonda: Financial Assistance Application

YMCA Camp Wakonda Tiered Pricing & Financial Assistance

At Camp Wakonda, we believe every child should have the opportunity to experience the magic of camp. To make this possible, we offer tiered pricing as well as partial scholarships for families who need further support.

Tiered Pricing
When registering, families may choose the tier that best fits their budget.

Tier A – $740
- Reflects the full cost of camp, including food, program supplies, facilities, and staffing. We kindly ask families to select this tier if they are able, as it helps us sustain camp for all.(This is the default price shown during registration. (CIT Tier A:$1040)
Tier B – $640
- A subsidized rate for families needing some assistance with camp costs.
  (CIT Tier B: $940)
Tier C – $540
- A larger subsidized rate for families who need additional help to make camp possible. (CIT Tier C: $840)
💡 No application is needed to use tiered pricing. Promo codes for each tier are provided during the registration process so families can select the rate that works best for them.

Financial Assistance
If your family cannot afford any of the tiered pricing options, you are encouraged to apply for financial assistance.
- Assistance is offered in the form of partial scholarships.
- We do not provide full scholarships, as this allows us to extend support to more families.
- Applications require families to share the amount they feel they can realistically contribute per camper.
Name of Guardian Completing Application*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please note that Camp provides partial scholarships only to families. We do not offer full scholarships, as our goal is to extend financial assistance to as many campers as possible. We kindly ask each family to share the amount they feel they can truly afford to contribute per camper, so that together we can make camp accessible to more children.
What is an amount you can afford to pay for a session of camp?*
Is there anything you want us to know while we review your application?
PART 1 CHILDREN ENROLLED IN THE PROGRAM
Number of Children attending camp?*
Name of Child 1*

First NameLast Name
Name of Child 2*

First NameLast Name
Name of Child 3*

First NameLast Name
Name of Child 4*

First NameLast Name
Birth Date of Child 1*

MonthDayYear
Date
Birth Date of Child 2*

MonthDayYear
Date
Birth Date of Child 3*

MonthDayYear
Date
Birth Date of Child 4*

MonthDayYear
Date
FOSTER CHILD
Is Child 1 a Foster Child, please type "Yes" or "No"
Is Child 2 a Foster Child, please type "Yes" or "No"
Is Child 3 a Foster Child, please type "Yes" or "No"
Is Child 4 a Foster Child, please type "Yes" or "No"
SNAP Case Number or N/A for Child 1
SNAP Case Number or N/A for Child 2
SNAP Case Number or N/A for Child 3
SNAP Case Number or N/A for Child 4
Temporary Assistance Case Number or N/A for Child 1
Temporary Assistance Case Number or N/A for Child 2
Temporary Assistance Case Number or N/A for Child 3
Temporary Assistance Case Number or N/A for Child 4
PART 2 HOUSEHOLD AND INCOME INFORMATION
List all members of the household including the children listed in Part 1. Indicate source and amount of current income for all members of the household before deductions, such as taxes and social security. Where there are wage earners and self-employed adults, the income of the wage earner cannot be offset by the business losses of the self-employed adult. If last month's income does not accurately reflect your circumstances, you may provide a projection of your current annual income. Irregular self-employed income may be averaged over the prior 12 months.
Number of household members (including adults and children)*
Please note: the form maxes out at 5 household members
Please report income based on annual estimates or using last year's tax reports

Check here
HOUSEHOLD MEMBERS & INCOME
Household Member 1

First NameLast Name
Annual Gross Wages for Household Member 1 or put N/A
Annual Welfare, Child Support, and/or Alimony for Household Member 1 or put N/A
Annual Pensions, Retirement, or Social Security for Household Member 1 or put N/A
Household Member 2

First NameLast Name
Annual Gross Wages for Household Member 2 or put N/A
Annual Welfare, Child Support, and/or Alimony for Household Member 2 or put N/A
Annual Pensions, Retirement, or Social Security for Household Member 2 or put N/A
Household Member 3

First NameLast Name
Annual Gross Wages for Household Member 3 or put N/A
Annual Welfare, Child Support, and/or Alimony for Household Member 3 or put N/A
Annual Pensions, Retirement, or Social Security for Household Member 3 or put N/A
Household Member 4

First NameLast Name
Annual Gross Wages for Household Member 4 or put N/A
Annual Welfare, Child Support, and/or Alimonyfor Household Member 4 or put N/A
Annual Pensions, Retirement, or Social Security for Household Member 4 or put N/A
Household Member 5

First NameLast Name
Annual Gross Wages for Household Member 5 or put N/A
Annual Welfare, Child Support, and/or Alimony for Household Member 5 or put N/A
Annual Pensions, Retirement, or Social Security for Household Member 5 or put N/A
PART 3: PARTICIPANT'S ETHNIC AND RACIAL INFORMATION (optional)
Please select all that apply to your family

Latino or HispanicAmerican Indian or Alaska NativeAsianBlack or African AmericanNative American or Pacific IslanderWhite
PART 4 SIGNATURE
I hereby certify that all information provided is correct and true and that all income is reported. I understand that this information is being given in connection with the receipt of federal funds, that institution officials may verify information, and that deliberate misrepresentation may subject me to prosecution under applicable state and federal laws.
SIGNATURE OF ADULT FAMILY MEMBER*

Clear
PRINTED NAME OF ADULT*
SOCIAL SECURITY NUMBER*
DATE*

MonthDayYear
Date
ADDRESS*
PHONE NUMBER*
Should be Empty:

YMCA Camp Wakonda Tiered Pricing & Financial Assistance

At Camp Wakonda, we believe every child should have the opportunity to experience the magic of camp. To make this possible, we offer tiered pricing as well as partial scholarships for families who need further support.

Tiered PricingWhen registering, families may choose the tier that best fits their budget.

Tier A – $740

PART 1 CHILDREN ENROLLED IN THE PROGRAM

FOSTER CHILD

PART 2 HOUSEHOLD AND INCOME INFORMATION

HOUSEHOLD MEMBERS & INCOME

PART 3: PARTICIPANT'S ETHNIC AND RACIAL INFORMATION (optional)

PART 4 SIGNATURE

Tiered Pricing
When registering, families may choose the tier that best fits their budget.