Campership Application 2021

1. Family Information

STOP - Does your family qualify for NJCK subsidy funding? To apply go to https://www.childcarenj.gov/Parents/SubsidyProgram. NOT SURE? Call 1-800-332-9227 to find out.

IF YOU DO NOT QUALIFY for NJCK continue filling out the form.

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* 1. Name of Parent(s)/ Guardian

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* 2. Home Address

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* 3. City, State, Zip

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* 4. Best Phone

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* 5. Email Address

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* 6. Ethnicity (for statistical purposes only)

Caucasian/White

African American/Black

Latino/Hispanic

Asian

Other (please specify)

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* 7. Please list all children in the family, indicate male or female, and age and indicate if you are applying for campership for that child. Please note we only provide assistance to children aged 3 - 12 years old.

Child 1 - Name, Gender, Age, Applying for Aid

Child 2 - Name, Gender, Age, Applying for Aid

Child 3 - Name, Gender, Age, Applying for Aid

Child 4 - Name, Gender, Age, Applying for Aid

Child 5 - Name, Gender, Age, Applying for Aid

Child 6 - Name, Gender, Age, Applying for Aid

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* 8. Total family size (include self)

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* 9. Please describe any special needs or circumstances that help explain your need for a scholarship.

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* 10. Parent(s)/Guardian Employer

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* 11. Employer Address

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* 12. Family Monthly Income

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* 13. Bergen Campership Fund uses photos of children on its website and in its annual report; we don not ever use the names of children or families.

Yes, the Campership Fund has permission to use my child's/children's picture

No, please do not use pictures of my child/children

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* 14. Parent Signature (if completing online, please type name)

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* 15. Please indicate the date you completed this application

Date / Time

Date