Camp Appalachia Summer Resident Camp Application
- Please fill out the following form for each child that will be participating in Resident Camp at Camp Appalachia.
- Resident Camp is open to all students between the ages of 7 and 17.
- Scholarships through a MissionWV Grant are available to some middle/high school campers from the following WV counties: Cabell, Boone, Logan, Lincoln and Mason counties
- Questions? Please contact Camp Director Jared Davis at j.davis@campappalachia.org
What week of Resident Camp are you interested in? *
Camper's Information
Please help us get to know your camper
Camper's Full Name *
Your answer
Camper's Age & Date of Birth (Open to campers ages 7-17) *
Your answer
Camper's Phone Number - If Applicable
Your answer
Camper's County of Residence *
Your answer
Does your child have any allergies? If yes, please list them below.
Your answer
Does your child have any medications that will need administered throughout the week? If yes, please list/explain below:
Your answer
Does your camper have any GOALS for the week?
Your answer
Parent/Guardian Information
Please provide information for parent/guardian in case of emergency.
Emergency Contact(s) Name & Best Phone Number *
Your answer
Mailing Address *
Your answer
Email *
Your answer
*** SCHOLARSHIPS ARE AVAILABLE***
Partial Grant funding has been supplied to cover a portion of the weekly cost per child for some Middle School & High School overnight campers from Boone, Cabell, Kanawha, Logan, Lincoln, Putnam, and Mason counties in WV. Please click YES below if you believe your camper may be eligible and would like more information regarding scholarship opportunities for your camper.

** For those that receive partial grant funding ($150 value), parents may be required to pay the remaining $90 of the weekly camper cost.
Contact Me About a Scholarship
By clicking YES, I agree to pay $240.00 per child per week (No Scholarship Awarded) OR $90 per child per week (after Scholarship Awarded) *
Required
How to Pay:
Please make checks payable to "Camp Appalachia".
In memo line write - "Resident Camp Registration"
Mail or Drop Off Payment to Attn: Brenda Good, Church @ The Depot, 6496 Teays Valley Road, Scott Depot, WV 25560
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