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2017 Project Kindle Interest Forms
Thanks for your interest in participating in one of our programs. As events are planned, information will be sent throughout the year. We're excited for you to join our Kindle family!

If you have more than one child interested in attending one of our programs, please fill out a new form for EACH child.

Email or call Eva Payne with any questions.

Email: eva@projectkindle.org
Phone: 877-800-2267 ext. 702

Thanks!

Email address
What Camp Kindle program are you interested in having your child/ren attend?
Child's Full Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Parent/Guardian's Full Name
Your answer
Full Address including City, State, and Zip Code
Your answer
Parent/Guardian's Phone including Area Code
Your answer
Parent/Guardian's Alternative Phone including Area Code
Your answer
Who in the family is impacted by a physical or mental health challenge? Choose all that apply.
Required
How did you hear about Project Kindle or any of its affiliate programs (SPEAK OUT, day camps, Camp Kindle, etc.)?
Your answer
The following items are OPTIONAL, but help with providing Camp Kindle with up-to-date information for funding purposes.
Household is Headed by
Income Range per MONTH
Number of children in the home age 0-5
Your answer
Number of children in the home age 6-10
Your answer
Number of children in the home age 11-13
Your answer
Number of children in the home age 14-16
Your answer
Number of children in the home age 17-24
Your answer
Race/Ethnic Background: Check all that apply.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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