Primary Parent/Guardian Name *

First Name

Last Name

Primary Phone Number *

(###)

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Camper Name #1 *

First Name

Last Name

Camper Name #2

First Name

Last Name

Camper Name #3

First Name

Last Name

Camper Name #4

Requesting a scholarship for more than four campers? Add any additional names to the bottom of this form.

First Name

Last Name

Camp(s) Applying to Attend: *

High School Camp

Middle School Camp

Elementary Camp

Day Camp

Check yes to any that apply:

One or more of these campers is currently in foster care

One or more of these campers splits their time between two households

One or more of these campers has a parent who is not a legal guardian

A parent/guardian is currently an active or retired nurse

By checking this box, I signify that I understand submission of application does not guarantee a scholarship. I also understand that, if accepted, a $10 'canteen fee' per camper will not be covered by scholarship money (your camper's canteen balance will be refunded at the end of the week) *

I understand that my submission does not guarantee any full or partial scholarship

I understand I will have to pay a $10 canteen fee per camper

I understand that if I receive any form of scholarship, I will still need to complete online registration to secure my camper's spot

I am interested in...

Coldstream has connections with many organizations that can potentially provide the services described below. When possible, we try to match you with an organization located in your county. Coldstream does not provide these resources and seeks only to facilitate relationships between individuals in need and those who may offer assistance. Checking a box does not guarantee you will be matched with a service provider.

Assistance with laundry

Transportation assistance

Grocery assistance

Relationship counseling or intervention

Connecting with a local church

Parenting classes/therapies (including co-parenting)

Small business resources (for those currently owning/operating a small business)

Housing assistance

Affordable extracurriculars/tutoring