SSCYC, INC.

"A Vacation with a Purpose"

CAMPERSHIP APPLICATION

SSCYC tries to help any camper who needs financial assistance in order to attend camp. Please know that we don't want to deny anyone the opportunity to attend camp, however, the demand for financial assistance is often high, and our resources are limited. We work with your church or youth group to provide as much assistance as possible.

ALL campers must pay the $250.00 registration fee at a minimum.

PARENT / GUARDIAN INFORMATION

Name	Full Name
Address	Street Address
	City State Zip Code
Telephone	Phone Number
Email	Email Address
Church/Youth Group

CAMPER INFORMATION

Please list each camper you have registered for camp this year

Camper(s)	Full Name Date of Birth
	Full Name Date of Birth
	Full Name Date of Birth
	Full Name Date of Birth
	Full Name Date of Birth

CAMPERSHIP INFORMATION

The following information is necessary in determining Campership awards and is kept strictly confidential.

How many adults and children in your household?

Adults Children

You have 0 camper(s) going to camp. The total tuition is $0.00..

Amount requested for campership?

Requested Amount

Please explain your special circumstances to validate this request. Failure to provide this will delay our ability to review your request.

You have characters left.

SUBMISSION INSTRUCTIONS

Please type your name below and review your digital signature.

By clicking "Submit Form", you certify that all the information above is true and accurate.

Print your name Date
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