Campership Application Form printable pdf download

Chickasaw Council, Boy Scouts of America

Campership Application

Kia Kima Scout Reservation & District Day Camps

Deadline April 15

of the calendar year of the camp requested

Scouting Information

Troop #__________ Pack #__________ District_________________________________________________________________

Scout’s Name_____________________________________________________________ Phone______________________________

Address___________________________________________________________ City, State, Zip______________________________

Email address (please print)_____________________________________________________________________________________

Rank in Scouting________________________________________________ Date Joined Unit________________________________

We are applying for assistance toward:

 Kia Kima Cub Resident Camp  Kia Kima Boy Scout Summer Camp  District Cub Scout Day Camp

Our group is registered for Camp the week of ______________________________________________________________________

Unit Leader Approval_________________________________________________________________________________________

Family Information

Parent or Guardian:

Mother_______________________________________________ Employer______________________________________________

Father________________________________________________ Employer______________________________________________

Financial Information

To give the camping committee a better understanding of the family’s financial status, please provide the following information. The information

will be held in strictest confidence. Camperships are generally awarded for no more than 50% of the total camp fee. The unit and parents should

pool resources for the difference.

Total Monthly Income $___________________________________________ Number of Family Members_____________________

Amount of campership desired $_________________________ (

Every Scout is responsible for a minimum of $40.00 towards the camp fee.)

Parent or Guardian Approval______________________________________________________________Date___________________

Additional information that should be considered by the committee:

____________________________________________________________________________________________________________

(continue on back side if necessary)

Council Approval________________________________________________________________________________Date______________________

Chickasaw Council

Boy Scouts of America

Campership Application Form