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 *

I confirm that our church has been asked for assistance prior to submitting this form (for youth and adult retreats). *

For youth or adult retreats: I confirm that I have applied for assistance from my home church/congregration and that my church has assisted in any way that it can.
I am attending a Hartland Sponsored Family Camp (not applicable)

Hartland wishes to partner with your church in helping you get to camp. Your local body of believers should be helping in any way they can.

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, needing to bring a nursing baby, etc.) *

Please provide any other pertinent information

Receive email updates from Hartland

Would you like information on these events?

How did you hear about this scholarship opportunity? *

We like to learn how we can best share this opportunity with others. Your feedback helps us to improve.