HERITAGE CAMPS FOR ADOPTIVE FAMILIES

FINANCIAL ASSISTANCE APPLICATION

NOTE: You must be registered for camp before applying for financial assistance. Financial assistance funds are awarded approximately one month prior to your camp. Please complete this form thoroughly and submit your financial assistance application. Thank you!

Applicant Information

First Name *

Last Name *

Address 1 *

City *

State *

Postal Code *

Phone *

Email Address *

Which Camp are you Attending? *

Marital Status *

Number of Adults Attending Camp *

Number of Children Attending Camp *

Family Income *

Total Number in Family Dependent on Income *

Lodging financial assistance Amount Requested (MUST INDICATE A DOLLAR AMOUNT BELOW, OR YOUR APPLICATION WILL BE REJECTED) *

Program Fee financial assistance Amount Requested (MUST INDICATE A DOLLAR AMOUNT BELOW, OR YOUR APPLICATION WILL BE REJECTED) *

Extenuating Circumstances that may have precipitated the need for financial assistance to attend camp this year. *

Please list additional areas where you may be able to volunteer before or during camp this year. For instance, help filling the family bags, loading the truck, helping when a volunteer is unable to during camp, etc. This is not required to receive financial assistance.