Form - Hartland Christian Camp

Name of church (if attending with your church group)

Name of person requesting Campership *

First

Last

Name of camper receiving Campership (attendee) *

First

Last

Gender *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email *

Date of camp attending *

Name of camp attending *

Has this camper received campership assistance in the past? *

Is this child currently in foster care? *

Caregiver/guardian phone *

Total cost for camp *

Any amount your church may be helping with:

If your church is providing any kind of financial assistance

Requested Scholarship Amount: *

Explain Need: (items to consider including are income level, size of household, any unusual expenses, etc.) *

Please provide any other pertinent information

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