Camp Fee Waiver Request Form

Camp Fee Waiver Request Form
Camp Activity Name
Camp Year
Amount to be Waived
Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Relationship
Parent/Guardian Contact Number

Area CodePhone Number
Basis of Your Request
I, the parent/guardian, is requesting for the camp fee to be waived.

The above-named applicant is from a household whose gross income level is shown below:

Household Income

	Annual	Monthly	Weekly
Gross Income

Household Members*
If you have any additional information that you want to add in support of your request for the Fee Waiver, please enter it below:
By signing this request form, parent and applicant confirm that the camp fee will be waived.
Applicant Signature

Clear
Parent Signature

Clear
For Camp Organizer Use Only
Submission Date

MonthDayYear
Date
Approval

YesNo
Reason (If not approved)
Organizer Representative Signature

Clear
Should be Empty:

Applicant Information