Scholarship Application Please enable JavaScript in your browser to complete this form.Household Info - Step 1 of 3Camper Name *FirstLastNicknameBirthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Name 2FirstLastNickname 2Birthdate 3MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Name 3FirstLastNickname 3Birthdate 3MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent/Guardian Name *FirstLastRelationship to Camper *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *NextCo-Pay *Amount you and other family members can contribute towards the camp fees.Who is financially responsible for this camper? *Is this camper part of the foster care system? *YesNoTotal Household Income *PreviousNextSession for which your camper is applyingPlease Rank your Session three Smiles for you first choice one smile for your last choice. we recommend a 1 week session for 7-8 year-olds. Two weeks is the maximum time for which we offer scholarship funding.Resident CampSession A *Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3July 12th to July 17th (one week) $1150Session B *Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3July 19th to July 31st (two weeks) $2300Session C *Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3August 2 to August 14 (two weeks) $2300Day CampSession 1Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3June 14th to June 18th (one week) $575Session 2Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3June 21th to July 2nd (two weeks) $1150Session 3Rate 1 out of 3Rate 2 out of 3Rate 3 out of 3July 05th to July 16th (two weeks) $1150Personal Statement *We require you to write a letter to the Screening committee describing your child, your families financial need, and why you think Camp Winnarainbow would be a good match for your Camper.Optional Additional Information (for community building and statistical purposesSelf Identified EthnicityIs this Camper associated with a homeless program?YesNoIs this Camper associated with any First Nations Tribes?YesNoWhich Tribe?Is this Camper associated with any Social Services Agency?YesNoWhich Agency?Does your Camper have a parent who is in prison?YesNoIs there anything else you would like us to know?CommentSubmit Application
