Camp NABS Financial Assistance | YMCA of the Fox Cities

Name of Child #1

First

Last

Suffix

Is Child #1 YMCA Member?

Yes

Has Child #1 Attended Camp Before?

Yes

Name of Child #2

First

Last

Suffix

Is Child #2 YMCA Member?

Yes

Has Child #2 Attended Camp Before?

Yes

Name of Child #3

First

Last

Suffix

Is Child #3 YMCA Member?

Yes

Has Child #3 Attended Camp Before?

Yes

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Family Email

Parent/Guardian #1 Name

First

Last

Suffix

Parent/Guardian #1 Phone

Parent/Guardian #2 Name

First

Last

Suffix

Parent/Guardian #2 Phone

Has your family received financial assistance this year for a YMCA program?

Yes

Total number of people in household:

Work status of Adult #1 in household:

Employed full-time

Employed part-time

Unemployed

Work status of Adult #2 in household:

Employed full-time

Employed part-time

Unemployed

Please briefly explain your need for assistance:

Name of camp program for Child #1

Camp Session Start Date for Child #1

Name of camp program for Child #2

Camp Session Start Date for Child #2

Name of camp program for Child #3

Camp Session Start Date for Child #3

Amount of the fee I can pay per child (minimum of $125 is requested)

Date

Parent Signature

Sign below