CCCYO Summer Camp Financial Assistance Application
Please complete all required information in all sections of this form.
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Email *
Some of our funding sources do not require families to meet the income eligibility guidelines. We encourage any family with a need to complete a financial assistance application.
Camper Information
You must complete this form for each camper in your household. For instance, if you have two campers you must complete this form twice. 
Camper Last Name: *
Camper First Name: *
My child would like to attend: *
Camper Address *
City *
State *
Zip Code *
County of Residence *
Birthdate *
MM
/
DD
/
YYYY
Name of School Attending *
Camper Identifies As (optional)
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While the approval of an application is based primarily upon economic need, we understand that there may be special circumstances. Please provide a short description of the camper's family situation or relevant information about the child, other than financial need.
Guardian First and Last Name *
Guardian Relationship to Camper *
Guardian Email Address: *
Guardian Phone Number: *
Sponsoring Agency:
Sponsoring Agency Contact Person:
Sponsoring Agency Phone Number:
Is the Camper a foster child, unhoused, or a runaway? *
Required
If the Camper is a foster child please include their case number and County here:
We are required to ask for information about your child's race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to the following questions is optional and does not affect your child's eligibility for financial assistance for camp.
Ethnicity (check one, optional):
Race (check one or more, optional):
What is the primary language spoken in the camper's household? (optional)
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