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Campership Application

NOTE: No camperships will be awarded at registration. You must submit a scholarship application at least two weeks prior to the beginning of camp.

Family Commitment: Please enter the portion of the camper fee that you anticipate being able to pay. We encourage you to put as much as possible towards your child’s camp fee so that we can give assistance to as many children as possible. Campership funds are limited and will be awarded based on family income and hardship situations. Please list each camper separately and the amount you can pay for each child separately under Family Commitment.

(All information is confidential)

Camper Name
Camper Date of Birth
Camper's Date of Birth
Family Commitment (of total cost)
Camper Name
Camper Date of Birth
Camper's Date of Birth
Family Commitment (of total cost)
Camper Name
Camper Date of Birth
Camper's Date of Birth
Family Commitment (of total cost)
Please complete all of the following information This form is not a camp registration form; camper is not registered until we receive this information AND a camper registration by mail or by fax. For assistance with completing payment of your Family Commitment over several months, contact Doug Mabey at (386) 647-6624 or dmabey@acvillage.net.
Person Making Request (your name)*
Relationship to Camper(s)*
Best Contact Number for You*
Best email address for you*
Your address (if different than campers)*
Street Address Address Line 2 City State ZIP Code
Camper's MONTHLY Family Income*
Total Number of People in Camper's Household*
Describe why you are requesting a campership*
Does the camper have a local church family?*
- Yes
- No
Do we have your permission to approach the local church with the opportunity to meet this need? (If no is selected, we will not contact the local church.)*
- Yes
- No
If yes, what is the name and address?*