CAMP FINANCIAL ASSISTANCE APPLICATION 2026

MONROE COUNTY YMCA SUMMER CAMP FINANCIAL ASSISTANCE APPLICATION 2026
FOR YOUTH DEVELOPMENT | FOR HEALTHY LIVING | FOR SOCIAL RESPONSIBILITY

Questions? Read our Summer Camp Financial Assistance FAQ: HERE
Applications for Summer Camp Financial Assistance (Camp FA) must be completed online and submitted by Saturday, February 28, 2026, in order to receive consideration. Applications can also be completed electronically at the kiosk located in the Welcome Center of either our respective branches. Scanned applications sent to us via email will NOT be accepted. Make sure you have a copy of your necessary documents ready to submit:
- Have a copy of your most current Federal Tax Return (Form 1040, pages 1 and 2 only or 1040EZ). Please mark out all Social Security numbers and tax ID numbers.
- Have two consecutive pay stubs for each income-earning member within the household. If you are unemployed, draw social security, or are a full-time student, please provide a summary of your unemployment benefits, SSI paperwork, financial aid benefits, and/or student schedule.
File Upload:*

Cancelof
Name of adult completing the application for the household:*

First NameLast Name
Address*

Street or PO Box

Apartment Number

CityState / Province

Zip
Number of residents residing in the primary applicant's household:*
Email Address*
Cell or Home Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.

Please list all household members below regardless of their intention to attend Summer Camp at the Y:

	Name	Relationship	Birthday	Name of School or Workplace	Attending Camp?

How many children in the family will be attending Summer Camp?*
Please add the names of the children below*
Applicant's Employer*
Hours Per Week*
Phone
Full-TimePart-TimeSelf-EmployedSeasonal WorkOther
Spouse Employer*
Hours Per Week*
Phone
Full-TimePart-TimeSelf-EmployedSeasonal WorkOther
Please describe your need for applying to receive financial assistance from the Y. (For example, disability, financial hardships, etc.).*

Financial HardshipDisabilityOther
Please explain in more detail:
Please itemize your Gross Monthly Income in the designated lines below. This form will calculate all of the income entered and multiply the value by 12. This is the Total Annual Income recorded in the designated box below.

Monthly Income*

	Primary Applicant	Spouse
Salary, Wages, and Tips
Unemployment Compensations
Child Support
Disability
Social Security Compensations
Aid for Dependent Children (AFDC)
Alimony
WIC
School Loan Income
Housing Allowance
Food Stamps
Other
Total Monthly Income
Total Annual Income

Signature of Applicant (Must be 18 or older)*

Clear
Financial Assistance Checklist:

1. Upload the most current Federal Income Tax Return (Form 1040, pages 1 and 2 only, or 1040EZ). Please mark out all Social Security numbers.

2. Upload a copy of two of your most recent paycheck stubs for each employed person listed on the application if a Federal Income Tax Return was not filed.

3. Please attach documentation to support the assistance income listed on this application.

4. Complete and sign the application.

5. All applicants will receive notification of the outcome of their request for Financial Assistance by March 10, 2026. When notified of your award, please register for Summer Camp (online or in person.) You must register and pay the $35 deposit for each week of Summer Camp before we can apply your scholarship credit. After registration, please email a Camp Leadership team member by March 31 at 5:00 pm to redeem your scholarship. Summer Camp enrollment is based upon a first-come, first-served basis and select sessions fill up quickly. Please note, receiving a scholarship does not guarantee enrollment in a respective week of Summer Camp.

By signing this application, I certify the information I have provided is true and complete. I understand any person who knowingly files an application containing any false, incomplete, or misleading information may have benefits revoked and be held personally responsible for all illegally obtained benefits.

I hereby give my consent for release of all the above information in order to be considered for Financial Assistance. I have attached all appropriate documentation. I understand this documentation will be used to assess the level of Financial Assistance that may be provided through the Y for All Scholarship Fund.

The potential Financial Assistance received only applies to the 2026 Summer Camp fees. A new Summer Camp Financial Assistance application is required for each calendar year.
PA Annual Income
Spouse Annual Income
Date*

MonthDayYear
Date
Should be Empty:

MONROE COUNTY YMCA SUMMER CAMP FINANCIAL ASSISTANCE APPLICATION 2026