2019_Financial Aid Application

Student Name*
(First and Last)

Name of Primary Income Provider*

Relation to Student*

Employment Status*

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*

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

Which school does your student currently attend?

How does your student identify their gender?

Primary guardian's relation to student

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

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?

May your student sign themselves out at the end of the day?

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