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Campership Request Form
Please enable JavaScript in your browser to complete this form.
Name of person requesting Campership
*
First
Last
Name of camper receiving Campership (attendee)
*
First
Last
Gender
*
Male
Female
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Email
*
Date of camp attending
*
Name of camp attending
*
Combo #1 Summer Camp
Combo #2 Summer Camp
Combo #1 Winter Camp
Combo #2 Winter Camp
Fall Quilt Retreat
Guest Group (your own church, school, or other event)
Home School Family Camp
Junior Winter Camp
Jr. High Winter Camp
Jr. High Summer Camp
Junior Summer Camp #1
Junior Summer Camp #2
Man Camp
Memorial Day Family Camp
Spring Quilt Retreat
Women's Retreat
Young Adult Camp
Has this camper received campership assistance in the past?
*
Yes
No
Is this child currently in foster care?
*
Yes
No
Caregiver/guardian phone
*
Total cost for camp
*
Amount of church support
If your church is providing any kind of financial assistance
Name of church
Requested scholarship amount
*
Number of children in household
*
Annual household income
*
Any unusual expenses
Please provide any other pertinent information
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