Scholarship Application

Scholarship Application
It is our wish that every child can experience a week of camp! We understand that at times money can obstruct this and so we want to help you find a way to send your kids to camp. Many donors have graciously made a way possible! Please fill out the information below and we will process it and give you an answer as soon as possible.
How many campers are you looking to send to camp?
Campers Name

First Name Last Name
Week applying for
Find camp week dates on our website bayouca.com/kids-camp
Campers Name

First Name Last Name
Week applying for
Find camp week dates on our website bayouca.com/kids-camp
Campers Name

First Name Last Name
Week applying for
Find camp week dates on our website bayouca.com/kids-camp
Campers Name

First Name Last Name
Week applying for
Find camp week dates on our website bayouca.com/kids-camp
Campers Name

First Name Last Name
Week applying for
Find camp week dates on our website bayouca.com/kids-camp
Parent/Guardian Name(s)

First Name Last Name
2nd Parent/Guardian

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Do you attend a church? If so, which one? *
Include city
Has your church been informed of the child's need? *

Yes No
How much are they able to assist per camper? *
How many people are in your household? *
Wage earner 1 occupation title/job title *
Wage earner 1 Yearly Income *
Wage earner 2 occupation title/job title
Wage earner 2 Yearly Income
Additional Household Income Amount? *
Including alimony, child support, social security, disability, public assistance, etc.
How much are you able to provide towards each camper's fee? *
Please feel free to add any additional information below.
Parent/Guardian Signature

Clear
Should be Empty:

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