All financial assistance notification will be sent by email

First Name *

Last Name *

Email *

Phone *

Address *

City *

State/Province *

Zip/Postal Code *

Country *

Current Status *

I am not currently receiving Financial Assistance

Receiving financial assistance this is for (Renewal or Request of another program)

Requesting Financial Assistance for: *

Summer Camp

Holiday Camp

Child's First Name *

Child's Last Name *

Household Income last year *

Please share with us your need for financial assistance in 500 words or less. *