Lockerly Arboretum Scholarship Form

Lockerly Arboretum SCHOLARSHIP

This is a 2-part application. Both parts must be received before consideration.
Camper Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender
Birthday

MonthDayYear
Date
Grade in September 2026
Summer Camp Sessions

Sapling Camp (rising 1st to 3rd) June 8-12Sapling Camp (rising 1st to 3rd) June 29-July 2Sapling Camp (rising 1st to 3rd) July 6-10Oak Camp (rising 4th to 6th) June 15-18Oak Camp (rising 4th to 6th) June 22-26Oak Camp (rising 4th to 6th) July 13-17
Camp T-Shirt Size (included in registration cost)

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
Food Allergies
Environmental Allergies
Medical Conditions
Prescriptions
Other Medical Information
Contact Information
Primary Contact Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Camper
Secondary Contact

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Camper
Camp Hours and Extended Care

Camp runs from 9:30 am to 3:30 pm (with drop off starting at 9:00 am and pick up extending until 4:00 pm). Pre and post camp care are available (from 7:30 – 9:00 am and 4:00 – 5:30 pm, respectively). These cost $20 / week each or $35 / week for both. Are you seeking financial support for extended care?
Will you need extended care

YesNo
If YES, Which care option do you require?

Before Camp CareAfter Camp CareBefore and After Camp Care
Where did you hear about our camp?

Word of MouthOnline SearchLockerly NewsletterSocial MediaSchool GroupTeacher Network / Educator GroupIn-Person community eventFlyer or PosterOther
Waiver & Release Form

Parental or Guardian Release
Liability Release

I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child as a result of participation in said event. This release is intended to discharge in advance Lockerly Arboretum, its officials, officers, employees, volunteers and agents from liability.

Parental Consent

I give consent for my child to participate in the above activities, and I execute the above liability release on their behalf. By signing this document, I authorize Lockerly Arboretum to publish photographs taken of me and/or my minor child(ren), and our names, for use on the Lockerly Arboretum website, social media and print materials.
Signature

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Name

First NameLast Name
Date

MonthDayYear
Date
Part 2
Second, submit two letters of interest/support.

One letter needs to be written by the camper expressing why they wish to come to Lockerly Summer camp, how they would contribute, and how they believe they would benefit from the experience.

The second letter needs to be written by a parent, guardian, teacher, or mentor expressing why this camper would make an outstanding addition to our summer camp and why financial aid is needed.

These letters can be mailed or emailed to the following address. Financial assistance applications will not be complete until both letters are received.

Lockerly Arboretum

P.O. Box 310

Milledgeville, GA 31059

Emailed: kenseyamerson@lockerly.org

All financial aid applications are due by April 17, 2026 and will be reviewed by a team of Lockerly staff. Campers will be notified, in writing, of the assistance they receive and the amount no later than May 8, 2026.
Should be Empty:

Lockerly Arboretum SCHOLARSHIP

Camper Information

Contact Information

Camp Hours and Extended Care

Waiver & Release Form

Part 2