Girl Guides Ontario - Summer Camps 2012 Campership Application

In order to apply for the Summer Camp Campership program, your camper must be a current girl Member of GGC. Please complete one application form per camper.

First Name:

Enter the camper's first name.

Last name:

Enter the camper's last name.

iMIS Number:

Please enter your iMIS number. If you do not have your iMIS number, leave this field blank.

Parent/Guardian applying:

It must be a parent or guardian who applies.

Phone number:

Email address:

What is your approximate gross (before tax) annual family income? (Consider all income sources from all parents/guardians.)

0 - 9,999 10,000 - 19,999 20,000 - 29,999 30,000 - 39,999 40,000 - 49,999 50,000 - 59,999 60,000 - 69,999 70,000 +

Please select the option that applies to your family:

Single parent family Single income, two parent family Two income, two parent family

Please select any of the following that apply to your family:

Receiving Ontario Works Receiving WSIB Benefits Receiving Ontario Disability Program Recently unemployed Part-time employment only Recently lost own business Own business doing poorly Parent is a student (full or part time) Adult in family suffers from diability/illness which causes financial hardship Child in family suffers from diability/illness which causes financial hardship Financially responsible for extended family

What is the total number of children supported in your family?

Additional reasons why financial assistance is requested at this time:

I have read the Campership Guidelines and Process.

Signature

I understand the purpose of the Campership program is to provide financial assistance for girls who would not otherwise be able to attend Summer Camp due to lack of funds. I also understand that the full amount requested may not be available if there are many requests for assistance. I agree to accept financial responsibility in excess of the benefits available from the Campership fund. I also understand that the Campership fund may not be used to subsidize travel, special equipment, or kit list items, and that this application will be held in the strictest confidence by Girl Guides of Canada, Ontario Council. I further understand that the responsibility to complete and deliver in a timely fashion all documentation pertinent to this application is my own. I also understand that the application will not be considered after the camper has arrived at camp.

Date:

retype the code you see in black letters (beside the box)

Enter the code

retype the code you see in black letters (beside the box)

Questions or concerns about this form?  Contact 1-877-323-4545 ext. 2461 or e-mail: summercamps@guidesontario.org.

Girl Guides Ontario - Girl Guides Ontario - Summer Camps 2012 Campership Application

Summer Camps 2012 Campership Application