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(s)

First Name Last Name
Campers Name(s)

First Name Last Name
Campers Name(s)

First Name Last Name
Campers Name(s)

First Name Last Name
Campers Name(s)

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

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?
Number of children under 18 at home?
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 camper fee?
Please state any particular circumstances which make financial help necessary and the reason why your child would benefit from coming to BaYouCa
Parent/Guardian Signature

Clear
Should be Empty: