Camp Watia Financial Assistance Application Parent/Guardian First Name Parent/Guardian Last Name Primary Phone Primary Email Child 1 First Name Child 1 Age Child 1 Gender Child 1 Race Child 1 Grade Child 2 First Name Child 2 Age Child 2 Gender Child 2 Race Child 2 Grade Child 3 First Name Child 3 Age Child 3 Gender Child 3 Race Child 3 Grade First Choice of Session Second Choice of Session Third Choice of Session Number of household members Monthly Income Annual Income AFCD per month (if applicable) Food Stamps per month (if applicable) Child Support per month (if applicable) Social Security per month (if applicable) Pensions per month (if applicable) Other income per month (if applicable) How many hours per week do you work? How many hours per week does your spouse/partner work? Paycheck Stub 1 One file only.128 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Paycheck Stub 2 One file only.128 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Paycheck Stub 3 One file only.128 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Tax Return One file only.128 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. How much could you possibly pay per week? Are you a single parent? - None -YesNo Are you or your camper a member of the EBCI? - None -YesNo Are you a full-time student? - None -YesNo Please list any extenuating circumstances for us to consider when reviewing your application. If your child has previously received Financial Assistance, how do you feel the program has helped your child? I authorize the YMCA to share my story. - None -YesNo Signature I acknowledge that if I am offered, and accept YMCA Financial Assistance, I understand that my portion of camp tuition must be paid on time and my account must be kept current. Failure to comply with the payment policies may jeopardize future financial assistance. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
