Springs Camp Application Form

First Name *

Last Name *

Name camper prefers

Date of Birth mm/dd/yyyy *

Camper’s Current Grade *

6th
7th
8th

How did you hear about the Springs Ambassador Camp?

Essay *

Household income *

Gender *

Race/Ethnicity (for reporting purposes only): *

White
African-American
Native American
Asian/Pacific Islander
Hispanic
Multiracial

I’m applying for (please check one): *

Full Tuition
Partial Scholarship
Full Scholarship

Address 1 *

Address 2

City *

State *

Zip / Post Code *

Phone *

Parents: *

Sole parent
Live together
Live separately
Divorced

Child lives with: *

Both
Parent 1
Parent 2

First Name Parent 1 *

Last Name Parent 1 *

Work Phone Parent 1

Cell/home Phone Parent 1 *

Email Parent 1 *

Address 1 Parent 1, Skip if same as camper

Address 2 Parent 1

City Parent 1

State Parent 1

Zip / Post Code Parent 1

First Name Parent 2

Last Name Parent 2

Email Parent 2

Work Phone Parent 2

Cell/home Phone Parent 2

Address 1 Parent, 2 Skip if same as camper

Should duplicate mailings be sent to: *

Parent 1
Parent 2

What is two plus 3? *

Springs Eternal Project

Applications must be sent by April 22, 2016

We’ll reply by May 3, 2016.

Springs Eternal Project

Springs Camp Application Form

Applications must be sent by April 22, 2016

We’ll reply by May 3, 2016.

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