2019_Financial Aid Application
Student Name
*
(First and Last)
Name of Primary Income Provider
*
Relation to Student
*
Employment Status
*
Currently Employed
Self-employed
Unemployed
Name of Employer
*
Occupation
*
Number of Years at Present Job
*
Net Monthly Income
*
Estimated Monthly Expenses
*
Net Yearly Income in 2018
*
Household Size
*
Federal/State Assistance
*
Yes
No
If yes, what kind?
Amount Can Contribute
*
Amount Asking
*
Additional Information
If you are not receiving assistance but still believe that you have financial hardships or extenuating circumstances (permanent or temporary) that qualify your child for a financial aid packet, please explain these hardships.
Information for Registration
If you have already registered online and reserved your spot with the $100 deposit, you do not need to answer the following questions.
Parent/Guardian Name
(First and Last)
What is your student's date of birth?
Student's grade in the fall of 2019
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Which school does your student currently attend?
How does your student identify their gender?
Decline to State
Female
Male
Other
Primary guardian's relation to student
Mother
Father
Family Member
Family Friend
Legal Guardian
Primary guardian's street address
Please include city, state, and zip code
Primary guardian's email
Primary guardian's phone number
Secondary guardian's name.
(First and last)
Secondary guardians phone number
Secondary guardian's email address
Emergency Contact Name
Emergency Contact Relation
Mother
Father
Family Member
Family Friend
Legal Guardian
Emergency Contact Phone
Please list all medications your student is currently taking.
Please describe all medical conditions or behavioral concerns we should be aware of. Please make sure to note any allergies.
May we administer over the counter pain medications to your student?
Yes
No
May your student sign themselves out at the end of the day?
Yes
No
If the answer is no, please list any adults able to sign them out with a Camp Coordinator
Is there anything else we should know about your student?
Send me a copy of my responses
Email address
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