Camp Partnership Application Form 2017
Complete application must be received at least 2 weeks before camp begins!
Pleasealso submit a proof of your household income, and your financial contribution toward the camp partnership.
PARENT/GUARDIAN INFORMATION:
Names of Parent(s)/Guardian(s): ______
Phone:(______)______Alternate Phone: ( ______)______
Email:______
Address ______
City ______Province ______Postal Code ______
*If the Ministry of Children and Families is the legal guardian, please provide Social Worker’s contact information and explain guardianship:
______
______
HOUSEHOLD INFORMATION:
Single Parent Family? Yes No # of adults (19+) in household: ______
# of children (0-18) in household: ______# of campers applying for partnership ______
Language(s) spoken at home: ______
SOURCE OF INCOME:
Please check all that apply, for all income-generating members of the household.
Income Assistance**
Employment Assistance
Disability**
Pension
Work: Full time or Part time (circle one)
Overseas Family Support
Other: ______
______
** If you are on Income Assistance or Disability, you are required to apply for the Summer Camp Subsidy through your assistance office. If you would like us to apply on your behalf, please write the address of your Income Assistance Office:
______
ANNUAL HOUSEHOLD INCOME:
Note! We require a Proof of Income for all income-generating members of the household, to be included with your application.
Less than $10,000 $10,000 - $14,999 $15,000 - $19,999 $20,000 - $24,999
$25,000 - $29,999 $30,000 - $34,999 $35,000 - $39,999 Above $40,000
Please list all family members applying for summer camp partnership: ______
______
Reason for Applying for the Partnership: (Please briefly explain family circumstances)
______
______
CAMPER INFORMATION:
Complete ALL sections for each camper and be sure to print clearly!
For more than two campers, please complete the additional camper forms for all campers applying.
Parent/Guardian Name(s) ______
How did you hear about this program? ______
Camper First Name ______Camper Last Name ______
Gender ______Birthdate (d/m/y)______/______/______ Age ______
Grade(as of Sept. 2016, or “Pre-K”/”Adult”) ______Care Card # ______-______-______
Name of Camp (from UGM’s list of 15 pre-approved camps)______
Camp Session ______Session Date ______
e.g. “Junior #3”. Remember, we do not sponsor day camp! e.g. “August 17-21”
Have you registered this camper for the camp requested already? (yes/no) ______
(If you are applying for Timberline Ranch Camp, please register online and select “pay by cheque” option to hold your spot.)
Has your child been sponsored by UGM previously? Yes No If yes, how many times? ______
Is the camper attending any other camps this summer? Yes No
If yes, which one(s)?______
(Camp name and sponsoring organization if applicable)
Camper First Name ______Camper Last Name ______
Gender ______Birthdate (d/m/y)______/______/______ Age ______
Grade(as of Sept. 2016, or “Pre-K”/”Adult”) ______Care Card # ______-______-______
Name of Camp (from UGM’s list of 15 pre-approved camps)______
Camp Session ______Session Date ______
e.g. “Junior #3”. Remember, we do not sponsor day camp! e.g. “August 17-21”
Have you registered this camper for the camp requested already?(yes/no) ______
(If you are applying for Timberline Ranch Camp, please register online and select “pay by cheque” option to hold your spot.)
Has your child been sponsored by UGM previously? Yes No If yes, how many times? ______
Is the camper attending any other camps this summer? Yes No
If yes, which one(s)?______
(Camp name and sponsoring organization if applicable)
I certify that all information provided is true and correct, to the best of my knowledge:
Guardian’s Full Name (please print)______
Guardian’s Signature ______ Date______