Melanie Mackenzie Memorial Camp Scholarship
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Email
*
example@example.com
Parent or Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian Contact Number
*
-
Area Code
Phone Number
Please enter the event or program for which you are requesting assistance.
*
Participant's Name
*
First Name
Last Name
Participant's Age
*
Please enter the amount of financial assistance requested.
*
Enter dollar value or % of program fee requested.
Brief description of why assistance is needed to participate in the above program.
*
Type a question
*
By checking this box I am verifying that without the assistance requested, the above participant would be unable to participate in the program listed without creating a financial hardship for the family or organization.
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