SCHOLARSHIP APPLICATION

Email Request Amount

Camper Name

First

Last

Parent/Grandparent/Guardian Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone

Camp Name

Camp Session Dates

Has Camper Already Registered?

Yes
No

Amount Church Can Provide

If applicable

Scholarship Request Amount

Home Church

If applicable

Additional Information

Agreement

Yes
No

I certify that the above information has been completed to the best of my knowledge.