Camp Cavell Adult/Family Campership Application
Please complete this application form and submit to Camp Cavell. We will contact you for phone interview after your application is submitted. We will notify you regarding the awarded amount after our review. Camperships are available on a first come, first received basis and/or until funds are depleted. *Notifications regarding Campership awards are generally made by email.
CONTACT PERSON
1st Adult for individual AND/OR family applications
Adult's First Name *
Your answer
Adult’s Last Name *
Your answer
Complete Home Address *
House Number & Road/Street Name
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
County *
Your answer
Total Household Income: *
Your answer
Phone Number *
We will be contacting you by phone. Important to give us CORRECT Numbers.
Your answer
Email *
We will be confirming campership awards by email. Important to give us CORRECT email.
Your answer
Occupation
Your answer
Place of Employment
Your answer
FAMILY Information (if applicable)
Please list functioning contact numbers and email addresses
2nd Adult
Full Name
Your answer
Full Address
Write "same" if same as 1st adult
Your answer
Primary Phone
Your answer
Alternate Phone
Your answer
Email
Your answer
Occupation
Your answer
Place of Employment
Your answer
Number of Children
Must fill out information about each child coming to camp.
Your answer
1st Child's Full Name
Your answer
Age
Your answer
Date of Birth
Your answer
2nd Child's Full Name
Your answer
Age
Your answer
Date of Birth
Your answer
3rd Child's Full Name
Your answer
Age
Your answer
Date of Birth
Your answer
4th Child's Full Name
Your answer
Age
Your answer
Date of Birth
Your answer
Additional Children
Please list their first name, last name and age
Your answer
Why are you requesting a Campership? *
Why should you or your family be considered for Campership assistance?
Your answer
SSI Benefits
If family receives SSI benefits, please provide case number.
Your answer
Food Stamps? *
Is Family receiving Food Stamps?
Other aid?
Please specify
Your answer
Household # *
Number of persons in household
Your answer
Circumstances *
Are there any extenuating circumstances you would like us to consider
Your answer
**Only a limited amount of Camperships are available. Additionally, you are expected to contribute a portion of the money needed for camp session.
Program Request *
Dates & Name of Program
Your answer
Name *
Signature Required
Your answer
*
I AFFIRM THAT THE INFORMATION ON THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE. In lieu of a signature, complete name above. Check Yes (or) No to validate information.
Yes
No
Comment or Questions
Your answer
IMPORTANT
PLEASE SUBMIT THIS COMPLETED CAMPERSHIP APPLICATION. Email office@campcavell.org Camp Cavell 3335 Lakeshore Road, Lexington, MI 48450
Submit
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