Adults and Children over 12 in Home
Children in Home (12 and under)
Monthly Income:
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