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!

  • Is Youth Haven a Good Fit For Your Child(ren)?

  • Here at Youth Haven we want to ensure every child is set up for success! A big part of that is making sure you, as a parent or guardian, are fully aware of our policies and expectations. We are aware that some children may struggle in a fast paced, high energy, group environment like camp. It's important you are clear that Youth Haven is not a clinical program and does not provide behavioral therapy or one-on-one care.

    Carefully read the following list to determine if Youth Haven is the best fit for your child. 

    • My child(ren) will function well in both large and small group settings without needing one-on-one support or assistance
    • My child(ren) will function well with a busy schedule that requires physical activity and frequent transitions from activity to activity
    • My child(ren) feel(s) comfortable sleeping away from home overnight
    • My child(ren) will function well in a high energy, often loud, environment
    • My child(ren) will not be a physical threat to the Youth Haven staff or other children 
  • I agree to these statements and will only list children that meet ALL of the above criteria.

  • 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?

  • We appreciate your honesty and for recognizing that Youth Haven's on site camp programs might not be the best fit for your child(ren).  While we love offering the chance for children to come and experience our camp programs, we also realize that a camp experience like Youth Haven's, may not be the best fit for many children.

    We would still love to help and offer them a chance to be part of our Adventure Club program, which offers fun and engaging mail sent each month as well as online fun.  If you're interested in signing them up for that program, please let Stephanie know and she can make that happen.  

    If things change as your child(ren) grow, please reach out and we can consider scheduling them at that time.  

  • 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

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