Full Name *

Email Address *

Parent #2 Full Name *

Parent #2 Email *

Address *

Child #1 Full Name *

Child #1 Age

Child #1 Grade

Child #2 Full Name *

Child #2 Age

Child #2 Age

Purpose of Scholarship *

Amount Requested

Religious Training (Please check all that apply) *

Name of School *

List all extracurricular activities (scouts, Key Club, etc)

Why do you want to go to camp, in the camper’s own words? *

Why should you be considered for this scholarship? *

Would you share your camp experience with the community? * Select an option Yes No

Name of Camp

Address *

Attn to (if known)