WildCare - Survey - WildCare Virtual Wildlife Camp Scholarship Request Form

WildCare wants to ensure that every child has a chance to participate in Virtual Wildlife Camp. If you feel that you will need financial assistance in order for your child to attend camp, please fill out and submit the form below.

Please note: your child is not enrolled in camp until you have received confirmation, either through email or over the phone from a WildCare staff member.

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Question - Required - Please check the box for the Virtual Winter Wildlife Camp for which you are applying for a scholarship:

	Morning Camp: 10am - 12pm, December 28, 2020 - January 1, 2021
	Afternoon Camp: 1pm - 3pm, December 28, 2020 - January 1, 2021

Question - Not Required - Child's full name:

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Question - Required - Name child goes by

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Question - Required - Child's age:

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Question - Required - Child's grade:

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Question - Required - Child's School:

Please complete the following parent or guardian information:

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

Yes, I would like to receive e-mail from WildCare

Keep me logged in. What's this?

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Question - Required - Best way to reach you? (Phone/text/email)

Parent / Guardian 2 (Optional)

Name:

First Required	Last Required

Email:

Phone Number:

Yes, I would like to receive e-mail from WildCare

Keep me logged in. What's this?

Please answer the following questions. You will be contacted within three (3) business days
regarding your scholarship application.

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Question - Required - Gross annual household income including government assistance:

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Question - Required - The fee for this camp is $250. The minimum contribution you wil be required to pay is $50. How much can you afford to contribute?

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Question - Required - Please briefly describe your household's need for a scholarship:

Please read and indicate your agreement:

I understand that any portion of the camp fee I pay is nonrefundable.

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Question - Required - Please click below: I agree

Please read our Terms of Use agreement (PDF) and click below to indicate that you have read and accepted the Terms.

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Question - Required - Please click below: I have read and agree.