Financial Aid Form - Ymca Camp Spaulding
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1YMCA CAMP SPAULDING
Financial Aid Form
Camper Name: _______________________________________________ Date of Birth: __________/__________/__________
YMCA Camp Spaulding believes that Every Kid Deserves Camp. We work all year to raise the funds to
make camp affordable to anyone who comes our way. We need the following information from you in
order to determine what we can offer:
Annual Household Income: ______________________________________
(Include all wages, SSI, TANF, food stamps and child support coming into the house)
Number of People living in the household: ___________________
Camp fees are determined based on family income. To determine the fee for your child, any of the
following forms of income verification will be accepted:
• 2 recent pay stubs
• A W2 form
• TANF benefit summary sheet
• Social Security/Survivor/Disability benefit summary sheet
• A copy of your tax return
Please include copies of your income verification with your camper’s registration form and send to:
Child and Family Services
103 North State Street
Concord, NH 03301
Attention: Camp Spaulding
Aid Scale
Number of Family Members
Family Income
2
3
4
5
6
7
8
$1-10,000
$50
$50
$50
$50
$50
$50
$50
$10,000-15,000
$75
$60
$50
$50
$50
$50
$50
$15,001-20,000
$150
$120
$90
$75
$60
$60
$50
$20,001-25,000
$225
$150
$120
$90
$75
$60
$50
$25,001-30,000
$300
$225
$175
$125
$100
$75
$60
$30,001-35,000
$425
$300
$225
$175
$150
$100
$75
$35,001-40,000
$550
$425
$300
$225
$175
$150
$100
$40,001-50,000
$650
$550
$425
$300
$225
$175
$150
$50,001-60,000
$750
$650
$550
$425
$300
$225
$175
$60,001 +
Full Cost of Camp
In signing below, I understand that the financial aid is given on a first come, first serve basis and does
have a limit of amount able to be distributed. Financial aid is based on how much money is raised and
what is determined appropriate based on our sliding scale.
Parent/Guardian Signature: _________________________________________________________ Date: ______/______/_____
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