Campership Application Form

Campership Application Form

Camp Akita Summer Camp 2023
This form is for families who have a desire to send their children to summer camp at Camp Akita, however, due to financial/personal hardship, are requesting special assistance. ONE FORM MUST BE FILLED OUT PER CHILD.

** THIS APPLICATION MUST BE RECEIVED BY June 1, 2023 IN ORDER TO BE ELIGIBLE. **

For any questions regarding our Campership program, please contact the Illinois Conference Youth Department at youthdept@ilcsda.org or call (630) 716-3555.
Camper Full Name*

First NameLast Name
Gender*

MaleFemale
Camper's Birthdate*

MonthDayYear
Camp Requesting*

Cubs Camp: June 18-25 (Ages 7-9)Junior Camp: June 18-25 (Ages 10-12)Tween Camp: June 25- July 2 (Ages 11-14)Teen Camp 1: July 2-9 (Ages 14-17)Teen Specialty Camp: July 9-16 (Ages 14-17)
Parents/Guardian Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Primary Phone Number*

Area CodePhone Number
Family Monthly Income*
Number of Adults in household*
Number of Children in household*
Does your child qualify for free or cost-reduced hot lunches at public school?*

Free Hot LunchReduced-Cost Hot LunchChild not in public school
Have you received assistance from the Campership Fund in the past?*

YesNo
Are you a member of the Seventh-day Adventist Church?*

YesNo
If so, which church?
Requested amount of Campership Funds (Maximum scholarship is $60 for each camper)*
Recommendations (Please list two, choosing from the following: Pastor, employer, work supervisor, teacher, etc. No family member, please!)
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
How I know this person. *
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
How I know this person.*
Please share with us your financial needs/hardship that might prevent your child from coming to camp. (This will be kept confidential)*
Should be Empty: