Youth Haven Individual Household Application

  • Individual Household Application

  • We are grateful to be able to offer free day camps, overnight or weekend camps, and summer camps for kids who have experienced some type of hardship in their lives. Examples include children in foster care, single-parent homes, low-income homes, or children with an incarcerated parent. Our day camps and overnight or weekend camps are available for ages 7-13, with longer camps during the summer for ages 8-13. Sponsors provide scholarships so all of these children can attend free of charge.

    If you feel your children would benefit from attending our weekend or summer camps and qualify to receive full scholarships, please completely fill out the information below and click "Submit" at the end of the form. This helps us to ensure we are helping those children and families who truly need it. Thank you!

  • Parent/Guardian Information

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  • Preferred Contact Method*
  • Marital Status*

  • Information on Children

  • Please Note: When children come to Youth Haven, they will participate in camp activities as a team of five or six, as well as in large groups for our all-camp activities. To help ensure a safe and successful experience for everyone, children need to be able to function in small groups and larger group settings; we are not staffed to provide constant one-on-one care. Thank you for your understanding. 

  • How did you hear about Youth Haven?*

  • Do any of the children have a currently incarcerated parent?
  • Have Your Children Been to Youth Haven Before?*
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?
  • Does this child have physical, emotional, or behavioral difficulties that might limit his/her ability to participate in some camp activities?
  • Within the past two years, did the child receive a Christmas gift from an incarcerated parent through Prison Fellowship Angel Tree?

  • Household Information

  • Annual Household Income*
  • Check all that apply to your household:
  • Does your family attend church?*
  • How Often?

  • Summary of Need

  • 0/500

  • Verification

  • Youth Haven is a non-denominational Christian outreach.
    PO Box 97, Rives Junction, MI  49277
    PO Box 716, Eloy, AZ  85131
    www.youthhaven.org

  • Should be Empty: