Apply for 2024 Youth Camp Scholars

Program Openings >> 2024 Youth Camp Scholars >> Apply

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:	2024 Youth Camp Scholars
ID:	1024
Location:	Hagerstown, MD
Program:	Youth Camp
Program Cost Range:	0.00
Contact Information
* First Name:
* Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
* Email:
Opt-In Confirmation
	I authorize recruiters from Circle of Trust Inc to send text messages from 8664029828 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.

Application for Summer Camp

Please read the following carefully. The Youth Summer Camp enrollment is on a first come, first served basis. The Camp can only accommodate 16 individuals.

APPLICATION DEADLINE: APRIL 22, 2024

Please complete this application in it entirety before you hit the submit button.

Please Note your parent will be require complete and sign a Parental Acknowledgement Form.

Acceptance notifications will be sent out in to your email on file by the end of May 21, 2024. If you are selected, we will send you a confirmation email and a link to complete the pre-camp paperwork packet. At this point you may then proceed with making your travel arrangements.

1. APPLICANT PRIMARY CONTACT INFORMATION

* Applicant Last Name::

* Applicant First Name::

* Applicant Middle Name::

Name you prefer to be called (if different from abve)::

* Applicant Phone Number
(Enter your parent number if you do not have a personal phone number)::

* Applicant Email Address:
(Enter your parent number if you do not have a personal phone number)::

* Gender::

	Male
	Female

* Date of Birth::

* Age (at the time of Camp)::

* SS Number::

* Are you a US Citizen::

	Yes
	No

* Country of Birth:

* Mailing Address:

* City::

* State::

* Zip Code::

2. PARENT / GUARDIAN PRIMARY CONTACT INFORMATION

First Parent/Guardian

* Name of Parent/Guardian/Primary Contact::

* Work Phone for Parent/Guardian/Primary Contact::

* Cell Phone for Parent/Guardian/Primary Contact::

* Email Address for Parent/Guardian/Primary Contact:

Mailing Address for Parent/Guardian:
(If different from above):

City for Parent/Guardian:
(If different from above):

State for Parent/Guardian:
(If different from above):

Zip Code for Parent/Guardian:
(If different from above):

Second Parent/Guardian

Name of Parent/Guardian/Primary Contact::

Work Phone for Parent/Guardian/Primary Contact::

Cell Phone for Parent/Guardian/Primary Contact::

Email Address for Parent/Guardian/Primary Contact:

Mailing Address for Parent/Guardian:
(If different from above):

City for Parent/Guardian:
(If different from above):

State for Parent/Guardian:
(If different from above):

Zip Code for Parent/Guardian:
(If different from above):

3. EMERGENCY CONTACT INFORMATION

First Emergency

* Name of Emergency Contact::

* Cell Phone for Emergency Contact::

* Relationship to Emergency Contact::

Second Emergency

* Name of Emergency Contact::

* Cell Phone for Emergency Contact::

* Relationship to Emergency Contact::

4. OTHER INFORMATION

* Are there other applicants you are hoping to attend the camp with?::

	Yes
	No

Name of Other Applicants::

* Are you planning to Drive or Fly to the Camp:

	Drive
	Fly

* If you are flying would you need a ride from the airport?:

	Yes
	No
	N/A

Is there anything else you would like us to know::

4. REFERENCES

Reference 1

* Name:

* Relationship:

* Phone Number:

* Email:

Reference 2

* Name:

* Relationship:

* Phone Number:

* Email:

5. ATTACHMENT

Attach Transcript

Please attach a copy of your school transcript (unofficial or official):

6. AUTHORIZATION

* I verify that all the information I have provided in this document is true to the best of my knowledge.:

	Yes
	No

* Signature (type name):

* Date:

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

Submit

Cancel