SMRCDC District 7 Summer Youth Pre-Enrollment

SMRCDC District 7 Summer Youth Pre-Enrollment

Please complete this pre-enrollment form to provide your organization's summer camp and program details.
Organization Information
Organization Name
Summer 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
Programs Offered - Other (Column 1)
Programs Offered - Other (Column 2)
Programs Offered - Other (Column 3)
Training / District Information
MSCS Food Bank Training Completion Date

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

MonthDayYear
Date
Should be Empty: