Montgomery County MD FCA

Campers Name:

Parent/Guardian's Name

Address

City

State

Zip

Parent/Guardian's Phone Number

Parent/Guardian's Email Address

Campers School

Grade Entering Fall 2024

Name of Church (if you attend one)

Name of FCA Camp

Other Camp Name - Type In the name of the camp not listed

Sport Choice

Amount you/your family can pay to send your child to camp

Has this camper (named on application) ever been to an FCA camp before?

If so, what camp & what year?

Has this camper (named on application) ever received an FCA Camp Scholarship before?

If so, what year?

Household 2023 Gross Income

Please list any other siblings & their grades (if applicable) entering Fall 2024.

Has the camper (named on application) been involved in FCA this past school year?

Please explain why your family needs a camp scholarship.

How did you hear about FCA & our summer camps?

Would you be willing to volunteer your time to help with our FCA Camps?

Date

Signature

PO Box 5612 Derwood, MD 20855