Form - Hartland Christian Camp

Church Name: *

Submitter Name: *

Email *

Phone *

(In case we have any questions for processing)

Type of Event (Hartland or Rental Church)

Date of Camp attending (Start Date) *

Event Name (Jr Winter Camp, EV Free Youth, etc.)

Total Cost of Camp (Per Camper)

Please note, Hartland's maximum scholarship only covers what is charged by Hartland to your church (we do not help cover transportation or additional costs your group may add to Hartland's rate)

Camper Info:

Camper #1 Name: *

First

Last

Camper #1 Address (use church address if unknown) *

Camper #1: Explain Need: (items may include are income level, size of household, any unusual expenses, etc.) *

Camper #1: List any Church support amounts: (church scholarship, fundraising, etc.) *

Camper #1: Types of Scholarships *

Do you have a second student to add? *

Yes
No

Camper #2 Name: *

First

Last

Camper #2 Address (use church address if unknown) *

Camper #2: Explain Need: (items may include are income level, size of household, any unusual expenses, etc.) *

Camper #2: List any Church support amounts: (church scholarship, fundraising, etc.) *

Types of Scholarships Camper #2: *

Do you have a 3rd student to add? *

Yes
No

Camper #3 Name: *

First

Last

Camper #3 Address (use church address if unknown) *

Camper #3: Explain Need: (items may include are income level, size of household, any unusual expenses, etc.) *

Camper #3: List any Church support amounts: (church scholarship, fundraising, etc.) *

Types of Scholarships Camper #3: *

Do you have a 4th student to add? *

Yes
No

Camper #4 Name: *

First

Last

Camper #4 Address (use church address if unknown) *

Camper #4: Explain Need: (items may include are income level, size of household, any unusual expenses, etc.) *

Camper #4: List any Church support amounts: (church scholarship, fundraising, etc.) *

Types of Scholarships Camper #4: *

Do you have a 5th student to add? *

Yes
No

Camper #5 Name: *

First

Last

Camper #5 Address (use church address if unknown) *

Camper #5: Explain Need: (items may include are income level, size of household, any unusual expenses, etc.) *

Scholarships are of

Camper #5: List any Church support amounts: (church scholarship, fundraising, etc.) *

Types of Scholarships Camper #5: *