Family Information

Parent 1 Name*

First Last

Birth Date*

First Year Attending Camp Ernst?*

OTHER FAMILY MEMBERS REQUESTING FEE ASSISTANCE (list names and birth dates)

Additional Info

Please provide any additional info in regards to week preference. Fee assistance can only be applied to one week.

Mailing Address*

Street Address City State ZIP Code

Parent Guardian Information

Phone #1*

Phone #1 Type*

Email*

Parent/Guardian #2

First Last

Phone #1

Phone #1 Type

Phone #2

Phone #2 Type

Email

Total Number of Adults and Children in Household*

Total Household Gross Income Per Year*

(Total household income including child-support, unemployment, public assistance, and other before deductions or “adjusted”/AGI on tax forms)

Any other info you need us to know?