Adults and Children over 12 in Home
Children in Home (12 and under)
Fill in all blanks. If not applicable, enter '0'
Fill in all blanks. If not applicable, enter '0
Total Household Monthly Expenses:
Would you like a visit from our church after the Holidays? (this has no effect on your application) Yes No
Would you like information in the spring on sending your child to a sleep-away camp in the summer? Yes No