SMRCDC District 7 Summer Youth Camp Application

SMRCDC District 7 Summer Youth Camp Application

Please complete this application for participation in the District 7 Summer Youth Camp. All fields are optional unless marked required.
Organization Name
Pastor Name/Camp Coordinator
Organization Top Executive (Person Responsible for Program)
Camp Mailing Address - Street
Camp Mailing Address - City
Camp Mailing Address - State
Camp Mailing Address - Zip Code
Camp Street Address
Organization EIN
Date Camp Started

MonthDayYear
Date
Number of Campers
Anticipated Camp End Date

MonthDayYear
Date
Programs Offered
Programs Offered - Other (Row 1)
Programs Offered - Other (Row 2)
Programs Offered - Other (Row 3)
MSCS Food Bank Training Completion Date

MonthDayYear
Date
Shelby County Commission District
Certification Name (Printed)
Certifying Officer of Organization
Certifying Officer Position
Certifying Officer Signature Date

MonthDayYear
Date
Signature of Certifying Officer
Should be Empty: