Scholarship Application

Child's Info

* Indicates required field

Child's Name *

First

Last

Child's Age *

Child's gender *

Male Female

Has he/she attended camp with us before? *

Yes No

For which camp are you requesting a scholarship? *

IMPACT Weekend Princess Camp IMPACT Camp Discovery Day Camp REMIX Camp- Overnight REMIX Camp- Day Camp D24 Camp Knights Camp

Is he/she already registered? *

Yes No

Your Name *

Relationship to child *

Your Email *

Your Phone Number *

Marital status *

Single Married Divorced Separated Widowed

Adults in household *

1 2 3 4+

Children in household *

1 2 3 4+

Total yearly household income *

Do you currently qualify for government assistance such as SNAP, medicaid, food stamps, medicaid, etc.? *

Yes No

Please explain your reason for your financial aid request, with emphasis on your recent or current hardship(s). *

How do you feel that a week/weekend at camp will benefit your child? *

Please "sign" this form by agreeing to the statement below and typing your full name in the space provided.

Choose Any *

The information I have provided is honest and accurate.

Electronic Signature *

Date *

Submit