Winter Camp Scholarship Assistance Application
​We are excited to be able to offer a limited number of 50% scholarship for Winter Camp. To be considered, please complete this application! Please only complete ONE application per family. All family members can be included on one form.

It is vital for all children who desire a scholarship to attend camp be listed on this application. We also need to know their age and the type of camp they are interested in.

Please be sure to include EVERYONE who lives in your home as well as the income they provide to your home.

Please note, you should get a confirmation message saying your application has been submitted. If you do not receive this message, your application has not gone through. This message should appear after you complete the application. It may take a few seconds for the confirmation to process and appear, please be patient and do not hit submit several times.

If you have any trouble please contact KJ Kelly at (269)521-3559.

Parent/Guardian Info
Please indicate the legal parent or guardians information below. We try to contact everyone through email, so please be sure to check your email regularly. We will need to contact you to verify the information you provide in your application as well as set up any potential scholarship. Please be sure this information is correct.
Guardian Name *
Your answer
Guardian Email *
Your answer
Guardian Phone Number *
Your answer
Guardian Address *
Your answer
Family Info
Please provide the requested information.
Please list ALL individual living in your home and the monthly total income each provide to your household. If someone has no income, please indicated none. (IE John - $500, Barbara - $1000, Johnnie - None) This should include ALL work wages, child support, disability income, SSI, AFDC, Alimony, WIC, SNAP, and any Other Income. *
Your answer
Does any member of you family have any special need or disability *
Please explain above indicated special needs or disabilities. *
Your answer
Are there any other special circumstances that should be taken into consideration? *
Please include any information you feel is important for us to consider when reviewing your application. Information provided here does NOT guarantee a scholarship will be awarded. We may require follow up information/verification based on the information provided.
Your answer
Child Info
Please list any children who you would like to be considered for scholarship as well as their age and the type of camp they would like to attend.
Child #1 Name *
Child's first and last name
Your answer
Child #1 Age *
Your answer
Child #1 Camp Type *
Required
Child #2 Name
Child's first and last name
Your answer
Child #2 Age
Your answer
Child #2 Camp Type
Child #3 Name
Child's first and last name
Your answer
Child #3 Age
Your answer
Child #3 Camp Type
Additional Children - please be sure to include Names, Ages and Day or Overnight Camp
Your answer
By "signing" below I certify that all information on this application is true and that all of our household income is reported. I understand that Camp Kidwell gets funding from various sources based on the information I give. I understand that Camp Kidwell officials may verify (check) the information. I understand that if I purposely give false information, my child may lose scholarship assistance and I may be prosecuted. I have been give all the time I need to read and understand this form. *
Required
Thank you for completing the scholarship application. We will contact you shortly to verify your income.
Information shared on this form will only be used to determine eligibility for scholarship assistance, and to verify that the information given is correct.
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