Reason (If not approved)
Full Name
First Name
Last Name
Relationship
Age
Approval
Approved
Not Approved
Submission Date
*
-
Month
-
Day
Year
Date
Organizer Representative Signature
*
Applicant Signature
*
Parent Signature
*
If you have any additional information that you want to add in support of your request for the Fee Waiver, please enter it below:
Parent/Guardian Contact Number
Parent/Guardian Name
*
First Name
Last Name
Full Name
First Name
Last Name
Relationship
Age
Full Name
First Name
Last Name
Relationship
Age
Full Name
First Name
Last Name
Relationship
Age
Full Name
First Name
Last Name
Relationship
Age
Relationship
Date of Birth
*
-
Month
-
Day
Year
Date
Address
Email
*
example@example.com
Name
*
First Name
Last Name
Phone Number
Amount to be Waived
Camp Year
Camp Activity Name
Date
*
-
Month
-
Day
Year
Date
Date
*
-
Month
-
Day
Year
Date
Print Form
Submit
Should be Empty: