Summer Day Camp Application

To register for assistance, please complete this form to the best of your ability. All of this imformation is necessary to determine eligibility for assistance.

Parent/Household Information

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Source of Income
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Do you recieve any non-cash benfits?
Are you survivor of domestic violence?
Are you or anyone in your household pregnant?
Has anyone in your household been affected by any of these?
Are you in need of any other sevices?