Campership Application Form Page 2
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1
2Silicon Valley Monterey Bay Council
Boy Scouts of America
C
A
AMPERSHIP
PPLICATION
INCOMPLETE APPLICATIONS WILL BE RETURNED!
PLEASE READ INSTRUCTIONS CAREFULLY BEFORE PROCEEDING.
Check One:
Pack
Troop
Team
Crew
Unit #_______ District___________
Camper’s Name (Last)__________________________________ (First)____________________________
Address:_____________________________________________City_____________________Zip_______
Home Phone: (
) _________________________ Other Phone: (
) _________________________
Child’s Age at Time of Camp:______ Birth Date: _____/___/______ Is child a foster child?
Yes
No
Father/Guardian’s Name: ________________________________ Occupation: _______________________
Email : ________________________________________ Cell/Work Phone: ________________________
Mother/Guardian’s Name: _______________________________ Occupation:_______________________
Email : ________________________________________ Cell Work Phone: ________________________
CAMP ATTENDING:
____Cub Day/Twilight Camp
___Cub Scout Resident
___Webelos Resident
____Boy Scout Resident @ Hi-Sierra ____Boy Scout Resident @ Pico Blanco
Date(s) your son will be attending camp: _______________________ Cost of camp $ ____________
Amount of campership requested $ ____ Number of other siblings attending a camp this summer: ____
MONTHLY FAMILY INCOME
Gross Monthly Income:
$______________
(salary, wages, commission, etc.)
All Other Assistance:
$______________
(alimony, welfare, AFDC, support, etc.)
Number of persons in household dependent on income: _____________
On a separate piece of paper please answer the following questions to help us evaluate your request.
1. Why do you want your Scout to attend camp?
2. How will the Scout be earning his portion of the camp fee?
3. Please have your Scout tell us in his own words why he wants to attend camp this summer?
FOR PARENT OR GUARDIAN:
In consideration of this campership application for sponsorship, I agree to the following conditions: (1) to
allow my child to attend camp; and (2) to contribute the amount of money specified for my child to attend
camp.
Parent/Guardian’s Signature: __________________________________________ Date: _______________
****NOTE: ALL information contained in this application is considered confidential****
SVMBC BSA: Date Received: ______________________________ Approved Campership $____________
Denied—Reason:____________________________________________________________
Approved by:___________________________________________ Date:________________
Date Letter Sent:_______________
O:\Data\PROGRAM\CAMPING\Camperships\2014_Campership_Application.doc
Confidential
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