Upon completion and receipt of this form, a camp representative will call for confirmation
2020 Campership Assistance Application
Chestnut Ridge Don Lee Rockfish
Name of Camper: _______________________________________________________
Name of Parent/Guardian: ________________________________________________
Phone: (Home:) __________________________ (Cell:)_________________________
Address: ______________________________________________________________
Sponsoring Church/Local Agency/Supporting Individual:__________________________
Church/Agency/Individual Phone: __________________________________________
Pastor Name/Agency Representative: _______________________________________
List the employer of each working member of the family:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
List the names and relationships of all persons living in the household:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Write a statement of financial need or hardship including information that needs to be taken into
consideration for assistance. (Use back of application if necessary.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What portion of the camp fees are you able to pay? $___________________________
Would you be able to make monthly payments? If so, how much per month? $_______
What portion of camp fees will be covered by your church/agency? $________________
What portion of camp fees do you request to be covered by a Campership? $_________
Parent __________________(name) requests Campership Assistance support from the NC UM
Camp & Retreat Ministries. Circumstances described above are accurate and true. I understand
that this application doesn’t guarantee Campership distribution and that if funds are not available to
meet this need, I may request a refund of the deposit.
Parent’s Signature: ____________________________ Date: ___________________
.