Camp Taloali Financial Assistance Application

Camp Taloali is proud to provide financial assistance to as many campers as possible each summer. Financial Assistance or “Camperships,” are provided through generous donations from individuals, organizations, and partners. Please complete the application and return to the Camp Taloali office for review.

Note: Please contact us if you need access to this form in another language or other accommodations to complete this application.

-To guarantee your campers spot in a session please register online and pay the deposit. If paying the deposit is a barrier to registering please call the office at (503) 400-6547 or email campadmin@taloali.org
-A separate application is required for each camper seeking assistance.
-Funding is limited; please apply as early as possible.

Financial assistance is awarded based on a number of criteria including financial need, special family circumstances, session capacity, and the amount of funds available.

Application Checklist:
❑ Register online for your selected session. Register at https://form.jotform.com/CampTaloaliAdmin/2022-camper-application
❑ Complete the application and attach copies of any requested income verification documents. Incomplete applications will be returned without being processed.
❑ Submit completed application either via email or send to the mailing address below:

Email:
-Please attach the form as a PDF
-Subject line should read Camp Taloali Financial Assistance
-Send the email to: campadmin@taloali.org

Mail:
Camp Taloali, Inc
PO Box 32,
Stayton, OR 97383

❑ Accept or Decline your offer by responding to the email from the camp registrar. At this time, you will need to set up payments to have your camper’s session paid in full at least one week before their camp session.

Applicant Name: (Family/Guardian name)*

First NameLast Name

Relationship to camper:*

Camper:*

First NameLast Name

Family/Guardian Email Address:*

example@example.com

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Phone Number (1)*

Please enter a valid phone number.Format: (000) 000-0000.

Contact Phone Number (2)

Please enter a valid phone number.Format: (000) 000-0000.

Online Registration Date:*

(Please be aware if you do not register online, you are not guaranteed space in the session until youcomplete the registration process)

Session fee for the child:*

$---.--

Income (Salary, wages, commission, ect)*

Agency Subsidy (SSI, AFDC, SSD, Food stamps, medical aid)*

Other (Alimony, Child support, rental property, investments, ect)*

You must provide monthly income verification if requested

Please List the total number of people in house hold living on the above income:*

Special Circumstances:*

Amount I am able to financial Contribute:*

YesNoOther

Please provide any additional information about your family’s financial need and circumstances here:*

File Upload

I certify that the information provided on this application is true and correct. I agree to provide additional documentation to verify need if requested. Furthermore, I understand that my eligibility will be reviewed upon request of Camp Taloali. Failure to provide updated information will result intermination of financial assistance. Camp Fire Taloali’s policy is to revoke financial assistance if payments are not made in a timely manner per our payment policies. Participants are subject to the policies and regulations of Camp Taloali.

Signature*

Date*

Date

Please call the Camp Taloali office at (503) 400-6547 with any questions or concerns.