Camp NABS Financial Assistance | YMCA of the Fox Cities

Name of Child #1

First

Last

Suffix

Name of Child #2

First

Last

Suffix

Name of Child #3

First

Last

Suffix

Family Email

Parent/Guardian #1 Name

First

Last

Suffix

Parent/Guardian #1 Phone

Parent/Guardian #2 Name

First

Last

Suffix

Parent/Guardian #2 Phone

Please briefly explain your need for assistance:

Name of camp program for Child #1

Camp Session Dates for Child #1

Name of camp program for Child #2

Camp Session Dates for Child #2

Name of camp program for Child #3

Camp Session Dates for Child #3

Do you expect any third-party payments towards your camp fees? (examples: LSS, CLTS, county assistance, etc.)

Amount of the fee I can pay per child (minimum of $125 is requested)

Date

Parent Signature

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