Summer Camp Scholarship Application Form
Child's Full Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Scholarship Amount Requested
*
$
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Family Information
Parent 1
Parent Name
*
First Name
Last Name
Cell Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
Parent Name
First Name
Last Name
Cell Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Additional Information
Child's Gender
Male
Female
Prefer not to say
Comments
Submit
Should be Empty: