2024 Summer Camp Financial Assistance Form

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Please fill out the below form in order to request need-based financial assistance. Each year CinemaKidz provides a certain amount of scholarship options. We recommend filling this out asap, as funds are limited. We expect families to be truthful, and reserve the right to ask for proof at anytime during the process. In the event any discrepancies are found, you will be responsible for the full price of camp. If you are requesting financial aid for more than 1 child, you must submit this form for EACH child.

Your Full Name *

Your Home Address *

Your Email Address *

Your Phone Number *

How many children/dependents are you financially responsible for? *

Secondary Guardian's Full Name (if applicable)

Secondary Guardian's Email Address (if applicable)

Are you: *

Married/living together in partnership with Secondary Guardian

Separated/Single, Secondary Guardian financially supports child/children

Single, I receive financial support from other resources including: family members, government assistance, etc.

Single, I am the sole financial support for my child/children

Other:

Your Annual or Weekly household income including any income reported on taxes, as well as government assistance (please note whether Annual or weekly) *

Has your current household income undergone any dramatic changes (increase and/or decrease) in the past 3 - 6 months? *

Your Total Yearly Household income *

Any other funds that go towards financially supporting child (child support, child savings account, assistance from family members, etc.) *

Please describe any extenuating circumstances, and/or reasons why you are requesting financial assistance for summer camp: *

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