Campership Financial Assistance Application

The Dahlem Conservancy provides financial assistance through the generous contributions received from friends, family, volunteers, foundations and businesses to underwrite camp fees to help campers participate in day camp opportunities. Financial assistance is granted on need and availability of funds. Completing this form does not guarantee approval. To apply, use this form. Please submit a separate application for each child. Fill out this form neatly and completely, listing and attaching all information requested along with completed child’s camp registration forms. All applicants are required to pay a $35 deposit (non-refundable). Camperships are restricted to one Financial Assistance Request per camper, per summer. Families are encouraged to contribute back to the financial assistance fund whenever possible. All information is confidential.

Today's Date*

Camper's Name*

First Last

Birth Date*

Age of Child on First Day of Camp*

Camp Session/Dates Attending*

Are you a Dahlem member?

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

School Name*

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Is a parent/guardian in the household currently unemployed?*

Yes
No

If yes, for how long?

Comments/Factors to Consider*

Comments/factors to be considered that impact the financial need. Explanations might include medical expenses, unemployment, divorce, death in the family, family emergency or other contributing factors:

INCOME INFORMATION: Please itemize your gross monthly household income; documentation is required for all income sources.

Salary, Wages, Tips*

Child Support*

Michigan Works*

Unemployment*

Alimony*

Social Security*

Food Stamps*

Retirement/Pension*

Total Monthly Income*

Number of Adults in the Household*

Number of Children (under 18) in the Household*

Amount Requested for Financial Assistance:*

Note: This form MUST accompany the camp registration forms for which assistance is requested. Any incomplete forms will be returned and will delay the process.

Please upload supporting income documentation

Most Recent Federal Tax Return
Max. file size: 40 MB.

Recent pay stub or verification of income
Max. file size: 40 MB.

Copy of government benefits, proof of housing assistance, etc.
Including free and reduced priced school meals family application
Max. file size: 40 MB.

Parent/Guardian Agreement: This application does not serve as acceptance to the financial assistance program. If my camper is awarded a campership, I will communicate to my camper that camp has rules and safety standards. Should your camper, for any reason, not adjust to camp life, you will be advised by the camp director or executive director and be asked to pick him/her up from camp. Additional payments beyond the $35.00 application fee (non-refundable) must be made in full no later than two weeks prior to the start of the chosen camp session.

Camper Agreement: I wish to attend Dahlem Outdoor Adventure Day Camp and agree to the camp rules; I agree to abide by the rules established for all campers and to use behavior appropriate to Dahlem Outdoor Adventure Day Camp expectations; to try new activities; to become part of my team group; respect the camp’s natural environment; and not to use illegal substances, or weapons. I understand that I may be sent home early if I do not follow camp rules and guidelines.

Deposit*
A $35 deposit (non-refundable) is required for each session/week for Outdoor Adventure Day Camp 2022
Price:

Total
$0.00

Consent*
- I affirm to the best of my knowledge that the information I provided is true and complete. I understand that if I falsify any of the above information, I will not be eligible for assistance.
- I realize that my campership application will not be processed until all documentation has been provided.
- I understand I will be responsible for any outstanding balances due to the Dahlem Conservancy.

I consent to the above statement.

Campership Financial Assistance Application

2023 Financial Assistance Request

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